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Dimopoulou D, Sotiri D, Kousi D, Loulou G, Raptaki K, Neofytou A, Dasoula F, Tampouratzi M, Koloi A, Eleftheriou E, Vergadi E, Papadimitriou E, Zorbadaki I, Mavridi A, Miliordos K, Steletou E, Strempela M, Fragkou PC, Spoulou V, Michos A, Gkentzi D, Papaevangelou V, Ladomenou F, Grivea I, Syrogiannopoulos G, Galanakis E, Zaoutis T, Tryfinopoulou K, Tsolia MN. SARS-CoV-2 seroprevalence among children in Greece during Omicron variant period. Eur J Pediatr 2024; 183:2491-2499. [PMID: 38478132 DOI: 10.1007/s00431-024-05486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/05/2024] [Accepted: 02/13/2024] [Indexed: 04/23/2024]
Abstract
The Omicron variant is associated with increased transmissibility, but evidence about the impact of Omicron in seropositivity of children is limited. This study aims to evaluate SARS-CoV-2 seroprevalence in children during the different variants' subperiods. A prospective multicenter seroprevalence study was conducted in 7 University public hospitals in Greece from November 2021 to August 2022 (3 subperiods: November 2021-February 2022, March 2022-May 2022, June 2022-August 2022). Children from different age groups, admitted to the hospital or examined in outpatient clinics for reasons other than COVID-19 were enrolled. Neutralizing antibodies (Nabs), anti-Spike (anti-S) and anti-nucleocapsid (anti-N) SARS-CoV-2 IgG in serum were evaluated. A total of 2127 children (males:57,2%; median age:4,8years) were enrolled. Anti-N IgG seropositivity increased from 17,8% in the first sub-period to 40,7% in the second sub-period and then decreased in the third sub-period (36,7%). Anti-S IgG seropositivity appeared to have an increasing trend over the study period, starting from 34,8% and reaching 80,7%. Children aged 1-4 years old have significantly higher anti-N IgG titers compared to children aged 0-1 years old (p < 0,001). Infants have significantly lower anti-S IgG titers compared to all other age groups (p < 0,001). Immunocompromised children and infants have the lowest seropositivity for NAbs.Conclusions During the Omicron period, seropositivity significantly increased, as a result of higher transmissibility. Neonates and infants have lower antibody titers compared to other age groups, while young children aged 1-4 years old present higher antibody titers, suggesting that this age group may mount a higher antibody response. Continuous surveillance seroprevalence studies are needed in children, in order to identify the true extent of SARS-CoV-2 and guide the planning of adequate public health measures.
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Affiliation(s)
- Dimitra Dimopoulou
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, 'P. and A. Kyriakou' Children's Hospital, Thivon and Leivadias, Athens, 30601, Greece
| | - Despoina Sotiri
- Central Public Health Laboratory, Hellenic Centre for Diseases Control and Prevention, Athens, Greece
| | - Dimitra Kousi
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, 15451, Greece
| | - Garyfallia Loulou
- Central Public Health Laboratory, Hellenic Centre for Diseases Control and Prevention, Athens, Greece
| | - Kalliopi Raptaki
- Central Public Health Laboratory, Hellenic Centre for Diseases Control and Prevention, Athens, Greece
| | - Ariadni Neofytou
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, 'P. and A. Kyriakou' Children's Hospital, Thivon and Leivadias, Athens, 30601, Greece
| | - Foteini Dasoula
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, 'P. and A. Kyriakou' Children's Hospital, Thivon and Leivadias, Athens, 30601, Greece
| | - Maria Tampouratzi
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, 'P. and A. Kyriakou' Children's Hospital, Thivon and Leivadias, Athens, 30601, Greece
| | - Athina Koloi
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, 'P. and A. Kyriakou' Children's Hospital, Thivon and Leivadias, Athens, 30601, Greece
| | - Eirini Eleftheriou
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, 'P. and A. Kyriakou' Children's Hospital, Thivon and Leivadias, Athens, 30601, Greece
| | - Eleni Vergadi
- School of Medicine, Department of Paediatrics, University General Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Eleni Papadimitriou
- School of Health Sciences, Faculty of Medicine, Department of Paediatrics, University General Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Irini Zorbadaki
- Department of Pediatrics, Venizeleion General Hospital, Heraklion, Greece
| | - Artemis Mavridi
- Attikon University Hospital, National and Kapodistrian University of Athens, Third Department of Paediatrics, Athens, Greece
| | | | - Evangelia Steletou
- Medical School, Department of Paediatrics, University of Patras, Patras, Greece
| | - Maria Strempela
- First Department of Paediatrics, Aghia Sophia' Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi C Fragkou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Spoulou
- First Department of Paediatrics, Aghia Sophia' Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Michos
- First Department of Paediatrics, Aghia Sophia' Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Despoina Gkentzi
- Medical School, Department of Paediatrics, University of Patras, Patras, Greece
| | - Vassiliki Papaevangelou
- Attikon University Hospital, National and Kapodistrian University of Athens, Third Department of Paediatrics, Athens, Greece
| | - Fani Ladomenou
- Department of Pediatrics, Venizeleion General Hospital, Heraklion, Greece
| | - Ioanna Grivea
- School of Health Sciences, Faculty of Medicine, Department of Paediatrics, University General Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - George Syrogiannopoulos
- School of Health Sciences, Faculty of Medicine, Department of Paediatrics, University General Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Emmanouil Galanakis
- School of Medicine, Department of Paediatrics, University General Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Theoklis Zaoutis
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, 'P. and A. Kyriakou' Children's Hospital, Thivon and Leivadias, Athens, 30601, Greece
| | - Kyriaki Tryfinopoulou
- Central Public Health Laboratory, Hellenic Centre for Diseases Control and Prevention, Athens, Greece
| | - Maria N Tsolia
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens, 'P. and A. Kyriakou' Children's Hospital, Thivon and Leivadias, Athens, 30601, Greece.
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Fragkou PC, Karagiannis SP, Dimopoulou D, Kefala S, Fligou F, Gallos P, Jahaj E, Bellou A, Koukaki E, Magira E, Orfanos P, Papathanakos G, Papathanasiou A, Pediaditis E, Pontikis K, Rovina N, Vaporidi K, Xenikakis M, Theodorakopoulou M, Kotanidou A. Intensive Care Unit Mortality Trends during the First Two Years of the COVID-19 Pandemic in Greece: A Multi-Center Retrospective Study. Viruses 2024; 16:488. [PMID: 38675831 PMCID: PMC11054592 DOI: 10.3390/v16040488] [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] [Received: 02/15/2024] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Data on COVID-19 mortality among patients in intensive care units (ICUs) from Eastern and/or Southern European countries, including Greece, are limited. The purpose of this study was to evaluate the ICU mortality trends among critically ill COVID-19 patients during the first two years of the pandemic in Greece and to further investigate if certain patients' clinical characteristics contributed to this outcome. We conducted a multi-center retrospective observational study among five large university hospitals in Greece, between February 2020 and January 2022. All adult critically ill patients with confirmed COVID-19 disease who required ICU admission for at least 24 h were eligible. In total, 1462 patients (66.35% males) were included in this study. The mean age of this cohort was 64.9 (±13.27) years old. The 28-day mortality rate was 35.99% (n = 528), while the overall in-hospital mortality was 50.96% (n = 745). Cox regression analysis demonstrated that older age (≥65 years old), a body mass index within the normal range, and a delay in ICU admission from symptom onset, as well as worse baseline clinical severity scores upon ICU admission, were associated with a greater risk of death. Mortality of critically ill COVID-19 patients was high during the first two years of the pandemic in Greece but comparable to other countries. Risk factors for death presented in this study are not different from those that have already been described for COVID-19 in other studies.
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Affiliation(s)
- Paraskevi C. Fragkou
- First Department of Critical Care and Pulmonary Diseases, Evangelismos General Hospital of Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece; (S.P.K.); (E.J.); (E.M.); (M.T.); (A.K.)
| | - Sotirios P. Karagiannis
- First Department of Critical Care and Pulmonary Diseases, Evangelismos General Hospital of Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece; (S.P.K.); (E.J.); (E.M.); (M.T.); (A.K.)
| | - Dimitra Dimopoulou
- Second Department of Pediatrics, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece;
| | - Sotiria Kefala
- Division of Anesthesiology and Intensive Care Medicine, School of Medicine, University of Patras, 26504 Patras, Greece; (S.K.); (F.F.); (A.B.)
| | - Fotini Fligou
- Division of Anesthesiology and Intensive Care Medicine, School of Medicine, University of Patras, 26504 Patras, Greece; (S.K.); (F.F.); (A.B.)
| | - Parisis Gallos
- Computational Biomedicine Laboratory, Department of Digital Systems, University of Piraeus, 18534 Piraeus, Greece;
| | - Edison Jahaj
- First Department of Critical Care and Pulmonary Diseases, Evangelismos General Hospital of Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece; (S.P.K.); (E.J.); (E.M.); (M.T.); (A.K.)
| | - Angeliki Bellou
- Division of Anesthesiology and Intensive Care Medicine, School of Medicine, University of Patras, 26504 Patras, Greece; (S.K.); (F.F.); (A.B.)
| | - Evangelia Koukaki
- Intensive Care Unit, First Department of Respiratory Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Chest Hospital, 11527 Athens, Greece; (E.K.); (K.P.); (N.R.)
| | - Eleni Magira
- First Department of Critical Care and Pulmonary Diseases, Evangelismos General Hospital of Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece; (S.P.K.); (E.J.); (E.M.); (M.T.); (A.K.)
| | - Philippos Orfanos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Georgios Papathanakos
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (G.P.); (A.P.); (M.X.)
| | - Athanasios Papathanasiou
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (G.P.); (A.P.); (M.X.)
| | - Emmanouil Pediaditis
- Department of Intensive Care Unit, University Hospital of Heraklion, School of Medicine, University of Crete, 70013 Heraklion, Greece; (E.P.); (K.V.)
| | - Konstantinos Pontikis
- Intensive Care Unit, First Department of Respiratory Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Chest Hospital, 11527 Athens, Greece; (E.K.); (K.P.); (N.R.)
| | - Nikoletta Rovina
- Intensive Care Unit, First Department of Respiratory Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Chest Hospital, 11527 Athens, Greece; (E.K.); (K.P.); (N.R.)
| | - Katerina Vaporidi
- Department of Intensive Care Unit, University Hospital of Heraklion, School of Medicine, University of Crete, 70013 Heraklion, Greece; (E.P.); (K.V.)
| | - Menelaos Xenikakis
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (G.P.); (A.P.); (M.X.)
| | - Maria Theodorakopoulou
- First Department of Critical Care and Pulmonary Diseases, Evangelismos General Hospital of Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece; (S.P.K.); (E.J.); (E.M.); (M.T.); (A.K.)
| | - Anastasia Kotanidou
- First Department of Critical Care and Pulmonary Diseases, Evangelismos General Hospital of Athens, National and Kapodistrian University of Athens, 10676 Athens, Greece; (S.P.K.); (E.J.); (E.M.); (M.T.); (A.K.)
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Dimopoulou D, Charakida M, Marmarinos A, Karaviti D, Avgeris M, Gourgiotis D, Tsolia MN. SARS-CoV-2 Antibody Kinetics in Unvaccinated Hospitalized Children With COVID-19. Pediatr Infect Dis J 2024:00006454-990000000-00758. [PMID: 38372544 DOI: 10.1097/inf.0000000000004301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Antibody levels decline a few months post-acute COVID-19, but humoral memory persists in adults. Age and disease severity may affect antibody responses. This study aims to evaluate the presence and durability of antibody responses in children with COVID-19. METHODS A prospective, single-center study, involving unvaccinated children 0-16 years of age who were hospitalized with COVID-19 between October 2020 and December 2021, was conducted. Serological testing for anti-Spike severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG and neutralizing antibodies was performed at diagnosis and at 1-, 3-, 6- and 12-months post-infection. RESULTS A total of 65 immunocompetent children were enrolled [mean age (±SD): 6.7 (±6.4) years; males: 56.9%]. At 3 months, 40/44 (91%) children were seropositive; seropositivity persisted in 22/26 (85%) children at 6 months and in 10/12 (83%) children at 12 months. There was no evidence that age was modifying the prediction of variance of SARS-CoV-2 IgG levels. In contrast, SARS-CoV-2 IgG levels varied with time and disease severity. The association with time was non-linear, so that with increasing time there was a significant reduction in SARS-CoV-2 IgG levels [coef, 0.044 (95% confidence interval {CI}: 0.061-0.028), P < 0.001]. For each increment of time, the higher disease severity group was associated with 0.9 lower SARS-CoV-2 IgG levels. Everyone varied from the average effect of time with an SD of 0.01, suggesting that individuals may have different trajectories across time. CONCLUSION Disease severity, but not age, influences antibody titers among children hospitalized with COVID-19. SARS-CoV-2 infection induces durable seroconversion in these children with detectable IgG levels at 1 year after infection.
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Affiliation(s)
| | | | - Antonios Marmarinos
- Laboratory of Clinical Biochemistry-Molecular Diagnostics, Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "P. & A. Kyriakou" Children's Hospital, Athens, Greece
| | | | - Margaritis Avgeris
- Laboratory of Clinical Biochemistry-Molecular Diagnostics, Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "P. & A. Kyriakou" Children's Hospital, Athens, Greece
| | - Dimitrios Gourgiotis
- Laboratory of Clinical Biochemistry-Molecular Diagnostics, Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, "P. & A. Kyriakou" Children's Hospital, Athens, Greece
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4
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Dallmeyer LK, Schüz ML, Fragkou PC, Omony J, Krumbein H, Dimopoulou D, Dimopoulou K, Skevaki C. Epidemiology of respiratory viruses among children during the SARS-CoV-2 pandemic: A systematic review and meta-analysis. Int J Infect Dis 2024; 138:10-18. [PMID: 37951460 DOI: 10.1016/j.ijid.2023.10.023] [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] [Received: 08/14/2023] [Revised: 10/03/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVE This meta-analysis aimed to assess the prevalence of respiratory viruses among children under the special conditions of the COVID-19 pandemic. METHODS Five databases were systematically searched to assess the pooled prevalence of various respiratory viruses in different age groups, regions, seasons, and in patients with and without confirmed SARS-CoV-2 coinfection. Moreover, we looked at the virus distribution in the first and second half of the pandemic and countries with distinct economic status. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed, and the systematic review was registered on PROSPERO (CRD42022379297). RESULTS Enterovirus/rhinovirus and human respiratory syncytial virus (HRSV) were the most prevalent pathogens among children. The prevalence of HRSV increased in the second half of the pandemic. The prevailing viruses vary according to the SARS-CoV-2-coinfection status, season, region, and country´s economic status. CONCLUSION This meta-analysis shows the epidemiology of respiratory viruses other than SARS-CoV-2 in children aged 0 to 12 years during the COVID-19 pandemic. Because major events, such as a pandemic, can alter epidemiology patterns, it is important to know them to improve health education measures, develop vaccines and medicines for vulnerable groups, as a guide for prevention strategies, and help with clinical decisions.
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Affiliation(s)
- Leonie K Dallmeyer
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Centre (UGMLC), Philipps University of Marburg, German Centre for LUNG Research (DZL), Marburg, Germany
| | - Marit L Schüz
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Centre (UGMLC), Philipps University of Marburg, German Centre for LUNG Research (DZL), Marburg, Germany
| | - Paraskevi C Fragkou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, Athens, Greece; European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV)
| | - Jimmy Omony
- Institute for Asthma and Allergy Prevention (IAP), Helmholtz Zentrum Munich, German Research Centre for Environmental Health (GmbH), Munich, Germany
| | - Hanna Krumbein
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Centre (UGMLC), Philipps University of Marburg, German Centre for LUNG Research (DZL), Marburg, Germany
| | - Dimitra Dimopoulou
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV); Second Department of Pediatrics, "Aghia Sophia" Children´s Hospital, Athens, Greece
| | | | - Chrysanthi Skevaki
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Centre (UGMLC), Philipps University of Marburg, German Centre for LUNG Research (DZL), Marburg, Germany; European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV).
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5
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Fragkou PC, Dimopoulou D, De Angelis G, Menchinelli G, Chemaly RF, Skevaki C. Editorial: Immune response to respiratory viruses and respiratory viral infections in susceptible populations. Front Med (Lausanne) 2023; 10:1330265. [PMID: 38046413 PMCID: PMC10693325 DOI: 10.3389/fmed.2023.1330265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Affiliation(s)
- Paraskevi C. Fragkou
- 1st Department of Critical Care Medicine and Pulmonary Services, Evaggelismos General Hospital, Athens, Greece
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland
| | - Dimitra Dimopoulou
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland
- 2nd University Department of Pediatrics, Panagiotis & Aglaia Kyriakou Children's Hospital, Athens, Greece
| | - Giulia De Angelis
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giulia Menchinelli
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roy F. Chemaly
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland
- University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Chrysanthi Skevaki
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center, Marburg, Germany
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Dimopoulou D, Mantadakis E, Koutserimpas C, Samonis G. A Narrative Review on the Role of Dalbavancin in the Treatment of Bone and Joint Infections. Antibiotics (Basel) 2023; 12:1492. [PMID: 37887193 PMCID: PMC10604335 DOI: 10.3390/antibiotics12101492] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Bone and joint infections (BJI) require prolonged antimicrobial treatment, leading to lengthy hospitalizations, high costs, the risk of nosocomial infections, and the development of antimicrobial resistance. Dalbavancin is a novel semisynthetic lipoglycopeptide approved for the treatment of adults and children with acute bacterial skin and skin structure infections. This narrative review aims to summarize the characteristics of dalbavancin and the current scientific evidence regarding its clinical efficacy and safety in the treatment of BJI. A literature search until June 2023 was performed to identify all published research about the role of dalbavancin in the management of BJI. Due to its unique pharmacokinetics characterized by prolonged half-life, high bactericidal activity against most Gram-positive bacteria, a good safety profile, and high tissue penetration, dalbavancin can be a valuable alternative to the treatment of BJI. Clinical studies have shown its non-inferiority compared to conventional therapies in BJI, offering potent activity against key pathogens and an extended dosing interval that may shorten hospitalization. In conclusion, dalbavancin represents a promising treatment option for BJI with a favorable safety profile, but further research in both adults and particularly children, who are ideal candidates for long-acting antibiotics, is necessary to evaluate the role of dalbavancin in BJI.
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Affiliation(s)
- Dimitra Dimopoulou
- Second Department of Pediatrics, “Aghia Sophia” Children’s Hospital, 115 27 Athens, Greece;
| | - Elpis Mantadakis
- Department of Pediatrics, University General Hospital of Alexandroupolis, 681 00 Alexandroupolis, Greece;
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 115 25 Athens, Greece;
| | - George Samonis
- Department of Medicine, University of Crete, 715 00 Heraklion, Greece
- First Department of Medical Oncology, “Metropolitan” Hospital, 185 47 Attica, Greece
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Moschopoulos CD, Dimopoulou D, Dimopoulou A, Dimopoulou K, Protopapas K, Zavras N, Tsiodras S, Kotanidou A, Fragkou PC. New Insights into the Fluid Management in Patients with Septic Shock. Medicina (Kaunas) 2023; 59:1047. [PMID: 37374251 PMCID: PMC10301281 DOI: 10.3390/medicina59061047] [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] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/25/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023]
Abstract
The importance of fluid resuscitation therapy during the early stages of sepsis management is a well-established principle. Current Surviving Sepsis Campaign (SSC) guidelines recommend the early administration of intravenous crystalloid fluids for sepsis-related hypotension or hyperlactatemia due to tissue hypoperfusion, within the first 3 h of resuscitation and suggest using balanced solutions (BSs) instead of normal saline (NS) for the management of patients with sepsis or septic shock. Studies comparing BS versus NS administration in septic patients have demonstrated that BSs are associated with better outcomes including decreased mortality. After initial resuscitation, fluid administration has to be judicious in order to avoid fluid overload, which has been associated with increased mortality, prolonged mechanical ventilation, and worsening of acute kidney injury. The "one size fits all" approach may be "convenient" but it should be avoided. Personalized fluid management, based on patient-specific hemodynamic indices, provides the foundations for better patient outcomes in the future. Although there is a consensus on the need for adequate fluid therapy in sepsis, the type, the amount of administered fluids, and the ideal fluid resuscitation strategy remain elusive. Well-designed large randomized controlled trials are certainly needed to compare fluid choices specifically in the septic patient, as there is currently limited evidence of low quality. This review aims to summarize the physiologic principles and current scientific evidence regarding fluid management in patients with sepsis, as well as to provide a comprehensive overview of the latest data on the optimal fluid administration strategy in sepsis.
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Affiliation(s)
- Charalampos D. Moschopoulos
- Fourth Department of Internal Medicine, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (C.D.M.); (S.T.)
| | - Dimitra Dimopoulou
- Second Department of Pediatrics, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece;
| | - Anastasia Dimopoulou
- First Department of Pediatric Surgery, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece
| | | | - Konstantinos Protopapas
- Fourth Department of Internal Medicine, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (C.D.M.); (S.T.)
| | - Nikolaos Zavras
- Department of Pediatric Surgery, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece; (C.D.M.); (S.T.)
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Paraskevi C. Fragkou
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, 10676 Athens, Greece
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Fragkou PC, De Angelis G, Menchinelli G, Can F, Garcia F, Morfin-Sherpa F, Dimopoulou D, Dimopoulou K, Zelli S, de Salazar A, Reiter R, Janocha H, Grossi A, Omony J, Skevaki C. Update of ESCMID COVID-19 guidelines: diagnostic testing for SARS-CoV-2. Clin Microbiol Infect 2023:S1198-743X(23)00192-1. [PMID: 37088423 PMCID: PMC10122552 DOI: 10.1016/j.cmi.2023.04.019] [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: 02/01/2023] [Revised: 04/13/2023] [Accepted: 04/16/2023] [Indexed: 04/25/2023]
Abstract
SCOPE Since the onset of coronavirus disease 2019 (COVID-19), several assays have been deployed for the diagnosis of SARS-CoV-2. The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) published the first set of guidelines on SARS-CoV-2 in-vitro diagnosis in February 2022. Since the COVID-19 landscape is rapidly evolving, the relevant ESCMID guidelines panel releases an update of the previously published recommendations on diagnostic testing for SARS-CoV-2. This update aims to delineate the best diagnostic approach for SARS-CoV-2 in different populations based on current evidence. METHODS An ESCMID COVID-19 guidelines task force was established by the ESCMID Executive Committee. A small group was established, half appointed by the chair, and the remaining selected with an open call. The panel met virtually once a week. For all decisions, a simple majority vote was used. A list of clinical questions using the PICO (population, intervention, comparison, and outcome) format was developed at the beginning of the process. For each PICO, two panel members performed a literature search focusing on systematic reviews with a third panellist involved in case of inconsistent results. The panel reassessed the PICOs previously defined as priority in the first set of guidelines and decided to address 49 PICO questions, as 6 of them were discarded as outdated/non-clinically relevant. The "Grading of Recommendations Assessment, Development and Evaluation(GRADE)-adoption, adaptation, and de novo development of recommendations (ADOLOPMENT)" evidence-to-decision framework was utilized to produce the guidelines. QUESTIONS ADDRESSED BY THE GUIDELINE AND RECOMMENDATIONS After literature search, we updated 16 PICO questions; these PICOs address the use of antigen-based assays among symptomatic and asymptomatic patients with different ages, COVID-19 severity status or risk for severe COVID-19, time since onset of symptoms/contact with an infectious case, and finally, types of biomaterials used.
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Affiliation(s)
- Paraskevi C Fragkou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, Athens, Greece; European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV)
| | - Giulia De Angelis
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV); Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS - 00168, Rome, Italy
| | - Giulia Menchinelli
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV); Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS - 00168, Rome, Italy; Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fusun Can
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV); Department of Medical Microbiology, Koc University School of Medicine, Istanbul, Turkey; Koc University IsBank Research Centre for Infectious Diseases (KUISCID), Istanbul, Turkey
| | - Federico Garcia
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV); Servicio de Microbiología Clínica. Hospital Universitario Clínico San Cecilio. Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain; Centro de Investigación Biomédicaen Red Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain
| | - Florence Morfin-Sherpa
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV); Laboratory of Virology, Institut des Agents Infectieux, National Reference Centre for respiratory viruses, Hospices Civils de Lyon, Université Claude Bernard Lyon1, Lyon, France
| | - Dimitra Dimopoulou
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV); Second Department of Paediatrics, "P. and A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Silvia Zelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS - 00168, Rome, Italy
| | - Adolfo de Salazar
- Servicio de Microbiología Clínica. Hospital Universitario Clínico San Cecilio. Instituto de Investigación Biosanitaria, Ibs.GRANADA, Granada, Spain; Centro de Investigación Biomédicaen Red Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain
| | - Rieke Reiter
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Centre (UGMLC), Philipps University Marburg, German Centre for Lung Research (DZL), Marburg, Germany
| | - Hannah Janocha
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Centre (UGMLC), Philipps University Marburg, German Centre for Lung Research (DZL), Marburg, Germany
| | | | - Jimmy Omony
- Institute for Asthma and Allergy Prevention (IAP), Helmholtz Zentrum Munich, German Research Centre for Environmental Health (GmbH), Munich, Germany
| | - Chrysanthi Skevaki
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV); Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Centre (UGMLC), Philipps University Marburg, German Centre for Lung Research (DZL), Marburg, Germany.
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9
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Dimopoulou D, Dasoula F, Liaska M, Eleftheriou I, Maritsi D, Tsolia M, Vartzelis G. Rise of Neurologic Manifestations During SARS-CoV-2 Omicron Wave in Children With COVID-19. Pediatr Infect Dis J 2023; 42:e128-e129. [PMID: 36728583 PMCID: PMC9990484 DOI: 10.1097/inf.0000000000003826] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Dimitra Dimopoulou
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, National and Kapodistrian University of Athens School of Medicine, “P. and A. Kyriakou” Children’s Hospital, Athens, Greece
| | - Foteini Dasoula
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, National and Kapodistrian University of Athens School of Medicine, “P. and A. Kyriakou” Children’s Hospital, Athens, Greece
| | - Marianthi Liaska
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, National and Kapodistrian University of Athens School of Medicine, “P. and A. Kyriakou” Children’s Hospital, Athens, Greece
| | - Irini Eleftheriou
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, National and Kapodistrian University of Athens School of Medicine, “P. and A. Kyriakou” Children’s Hospital, Athens, Greece
| | - Despoina Maritsi
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, National and Kapodistrian University of Athens School of Medicine, “P. and A. Kyriakou” Children’s Hospital, Athens, Greece
| | - Maria Tsolia
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, National and Kapodistrian University of Athens School of Medicine, “P. and A. Kyriakou” Children’s Hospital, Athens, Greece
| | - George Vartzelis
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, National and Kapodistrian University of Athens School of Medicine, “P. and A. Kyriakou” Children’s Hospital, Athens, Greece
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10
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Fragkou PC, Moschopoulos CD, Dimopoulou D, Ong DSY, Dimopoulou K, Nelson PP, Schweitzer VA, Janocha H, Karofylakis E, Papathanasiou KA, Tsiordras S, De Angelis G, Thölken C, Sanguinetti M, Chung HR, Skevaki C. Performance of point-of care molecular and antigen-based tests for SARS-CoV-2: a living systematic review and meta-analysis. Clin Microbiol Infect 2023; 29:291-301. [PMID: 36336237 PMCID: PMC9660861 DOI: 10.1016/j.cmi.2022.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/05/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Molecular and antigen point-of-care tests (POCTs) have augmented our ability to rapidly identify and manage SARS-CoV-2 infection. However, their clinical performance varies among individual studies. OBJECTIVES The evaluation of the performance of molecular and antigen-based POCTs in confirmed, suspected, or probable COVID-19 cases compared with that of laboratory-based RT-PCR in real-life settings. DATA SOURCES MEDLINE/PubMed, Scopus, Embase, Web of Science, Cochrane Library, Cochrane COVID-19 study register, and COVID-19 Living Evidence Database from the University of Bern. STUDY ELIGIBILITY CRITERIA Peer-reviewed or preprint observational studies or randomized controlled trials that evaluated any type of commercially available antigen and/or molecular POCTs for SARS-CoV-2, including multiplex PCR panels, approved by the United States Food and Drug Administration, with Emergency Use Authorization, and/or marked with Conformitè Europëenne from European Commission/European Union. PARTICIPANTS Close contacts and/or patients with symptomatic and/or asymptomatic confirmed, suspected, or probable COVID-19 infection of any age. TEST/S Molecular and/or antigen-based SARS-CoV-2 POCTs. REFERENCE STANDARD Laboratory-based SARS-CoV-2 RT-PCR. ASSESSMENT OF RISK OF BIAS Eligible studies were subjected to quality-control and risk-of-bias assessment using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. METHODS OF DATA SYNTHESIS Summary sensitivities and specificities with their 95% CIs were estimated using a bivariate model. Subgroup analysis was performed when at least three studies informed the outcome. RESULTS A total of 123 eligible publications (97 and 26 studies assessing antigen-based and molecular POCTs, respectively) were retrieved from 4674 initial records. The pooled sensitivity and specificity for 13 molecular-based POCTs were 92.8% (95% CI, 88.9-95.4%) and 97.6% (95% CI, 96.6-98.3%), respectively. The sensitivity of antigen-based POCTs pooled from 138 individual evaluations was considerably lower than that of molecular POCTs; the pooled sensitivity and specificity rates were 70.6% (95% CI, 67.2-73.8%) and 98.9% (95% CI, 98.5-99.2%), respectively. DISCUSSION Further studies are needed to evaluate the performance of molecular and antigen-based POCTs in underrepresented patient subgroups and different respiratory samples.
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Affiliation(s)
- Paraskevi C Fragkou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; The European Society of Clinical Microbiology and Infection Study Group for Respiratory Viruses, Basel, Switzerland
| | - Charalampos D Moschopoulos
- The European Society of Clinical Microbiology and Infection Study Group for Respiratory Viruses, Basel, Switzerland; Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitra Dimopoulou
- The European Society of Clinical Microbiology and Infection Study Group for Respiratory Viruses, Basel, Switzerland; Second Department of Paediatrics, 'Panagiotis and Aglaia Kyriakou' Children's Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - David S Y Ong
- The European Society of Clinical Microbiology and Infection Study Group for Respiratory Viruses, Basel, Switzerland; Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Philipp P Nelson
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center, Philipps University Marburg, German Center for Lung Research (DZL) Marburg, Marburg, Germany
| | - Valentijn A Schweitzer
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Hannah Janocha
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center, Philipps University Marburg, German Center for Lung Research (DZL) Marburg, Marburg, Germany
| | - Emmanouil Karofylakis
- The European Society of Clinical Microbiology and Infection Study Group for Respiratory Viruses, Basel, Switzerland; Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Konstantinos A Papathanasiou
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Sotirios Tsiordras
- The European Society of Clinical Microbiology and Infection Study Group for Respiratory Viruses, Basel, Switzerland; Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Giulia De Angelis
- Dipartimento di Scienze biotecnologiche di base, cliniche intensivologiche e perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Clemens Thölken
- Center for Synthetic Microbiology, Philipps-Universität, Marburg, Germany
| | - Maurizio Sanguinetti
- Dipartimento di Scienze biotecnologiche di base, cliniche intensivologiche e perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Ho-Ryun Chung
- Institut für Medizinische Bioinformatik und Biostatistik, Philipps-Universität Marburg, Marburg, Germany
| | - Chrysanthi Skevaki
- The European Society of Clinical Microbiology and Infection Study Group for Respiratory Viruses, Basel, Switzerland; Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center, Philipps University Marburg, German Center for Lung Research (DZL) Marburg, Marburg, Germany.
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11
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Dimopoulou A, Dimopoulou D, Zavras N, Kontaki E, Vaos G, Fessatou S. Ileal bypass for pruritus relief in a 3-year-old boy with advanced progressive familial intrahepatic cholestasis: how effective is it? Folia Med (Plovdiv) 2023; 65:183-185. [PMID: 36855993 DOI: 10.3897/folmed.65.e73628] [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: 08/28/2021] [Accepted: 01/24/2022] [Indexed: 03/02/2023] Open
Abstract
Progressive familial intrahepatic cholestasis (PFIC) is a group of liver disorders that manifest in early childhood with cholestasis and pruritus resulting progressively in liver failure. We present a case of a 3-year-old boy with advanced PFIC from refractory pruritus. In order to offer an effective treatment of pruritus, our patient underwent ileal bypass and after a 2-month period free of symptoms, unexpectedly relapsed after a Rota viral infection. Finally, the child underwent orthotopic liver transplantation. Patients with advanced PFIC do not seem to benefit from nontransplant invasive interventions regarding the relief of pruritus.
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Affiliation(s)
| | | | - Nikolaos Zavras
- National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Kontaki
- Leeds Children's Hospital, Leeds, Leeds, United Kingdom
| | - George Vaos
- National and Kapodistrian University of Athens, Athens, Greece
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12
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Fragkou PC, Moschopoulos CD, Dimopoulou D, Triantafyllidi H, Birmpa D, Benas D, Tsiodras S, Kavatha D, Antoniadou A, Papadopoulos A. Cardiovascular disease and risk assessment in people living with HIV: Current practices and novel perspectives. Hellenic J Cardiol 2023; 71:42-54. [PMID: 36646212 DOI: 10.1016/j.hjc.2022.12.013] [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: 08/11/2022] [Revised: 11/28/2022] [Accepted: 12/31/2022] [Indexed: 01/15/2023] Open
Abstract
Human immunodeficiency virus (HIV) infection represents a major cardiovascular risk factor, and the cumulative cardiovascular disease (CVD) burden among aging people living with HIV (PLWH) constitutes a leading cause of morbidity and mortality. To date, CVD risk assessment in PLWH remains challenging. Therefore, it is necessary to evaluate and stratify the cardiovascular risk in PLWH with appropriate screening and risk assessment tools and protocols to correctly identify which patients are at a higher risk for CVD and will benefit most from prevention measures and timely management. This review aims to accumulate the current evidence on the association between HIV infection and CVD, as well as the risk factors contributing to CVD in PLWH. Furthermore, considering the need for cardiovascular risk assessment in daily clinical practice, the purpose of this review is also to report the current practices and novel perspectives in cardiovascular risk assessment of PLWH and provide further insights into the development and implementation of appropriate CVD risk stratification and treatment strategies, particularly in countries with high HIV burden and limited resources.
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Affiliation(s)
- Paraskevi C Fragkou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | - Charalampos D Moschopoulos
- Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitra Dimopoulou
- Second Department of Pediatrics, Children's Hospital "Panagiotis and Aglaia Kyriakou", National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Helen Triantafyllidi
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dionysia Birmpa
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios Benas
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Sotirios Tsiodras
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitra Kavatha
- Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Anastasia Antoniadou
- Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Antonios Papadopoulos
- Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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13
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Dimopoulou D, Kyritsi M, Dadouli K, Vergadi E, Tsiligianni E, Papadimitriou E, Mavridi A, Giannakopoulos S, Tsiourvopoulou G, Palyvou M, Angeli E, Brikos N, Eleftheriou I, Spoulou V, Michos A, Gkentzi D, Siomou E, Papaevangelou V, Grivea I, Syrogiannopoulos G, Galanakis E, Hadjichristodoulou C, Tsolia M. Seroprevalence of anti-SARS-CoV-2 antibodies among children and their parents in Greece. Eur J Pediatr 2023; 182:439-449. [PMID: 36383284 PMCID: PMC9666986 DOI: 10.1007/s00431-022-04681-8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
UNLABELLED School closures were enforced as measures to restrain the COVID-19 pandemic, based on the assumption that young children may play a key role in SARS-CoV-2 spread. This study aims to determine the prevalence of SARS-CoV-2 IgG antibodies in children and corresponding parents, in order to improve surveillance and estimate the prevalence of asymptomatic or subclinical COVID-19 cases. A prospective multicenter study was conducted between March and June 2021 in Greece. Children admitted to the hospital or examined in outpatient clinics for reasons other than COVID-19 and their parents were tested for anti-Spike SARS-CoV-2 IgG in serum. A questionnaire about clinical and demographic data was completed. The study included 823 participants: 427 children and 396 corresponding parents. The overall seroprevalence was 16.4% in parents and 13.8% in children. Among families with ≥ 1 seropositive child or parent, the combination of a seropositive parent and a corresponding seronegative child was 29.6%, a seronegative parent and a corresponding seropositive child was 24.7%, and a seropositive child with a corresponding seropositive parent was 45.7%. Age, level of education, and school or work attendance were not significantly associated with increased seropositivity. On the contrary, ethnic minority of Roma, close contact with known COVID-19 case, previous symptoms consistent with COVID-19, and mass gatherings were risk factors for seropositivity. CONCLUSION The spread of SARS-CoV-2 during a period of lockdown in Greece was low in children and comparable to adults most likely due to intrafamilial transmission. Accordingly, it is unlikely that children have boosted virus transmission. WHAT IS KNOWN • In the earliest months of the pandemic, it was demonstrated that children had significantly lower seroprevalence rates than the older age groups, due to the fact that children had decreased exposure to the virus, because of early public health interventions, such as school and day care closure. • Later, further studies reported that children have similar incidence rate of SARS-CoV-2 infection compared to adults in households and community settings. WHAT IS NEW • In this seroprevalence study, the spread of SARS-CoV-2 infection during a period of lockdown in Greece with the predominance of the Alpha-variant was particularly low in children and comparable to adults, most likely due to intrafamilial transmission. • These study findings will be useful for decisions regarding non-pharmaceutical interventions during the pandemic, and especially, to guide in designing and implementing appropriate containment measures for schools and social gatherings.
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Affiliation(s)
- Dimitra Dimopoulou
- Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, Second Department of Paediatrics, Thivon and Leivadias Str, 11526, Athens, Greece.
| | - Maria Kyritsi
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Katerina Dadouli
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Eleni Vergadi
- School of Medicine, Department of Paediatrics, University of Crete, University General Hospital of Heraklion, Heraklion, Greece
| | | | - Eleni Papadimitriou
- School of Health Sciences, Faculty of Medicine, Department of Paediatrics, University General Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Artemis Mavridi
- Third Department of Paediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Maria Palyvou
- Medical School, Department of Paediatrics, University of Patras, Patras, Greece
| | - Evangelia Angeli
- Medical School, Department of Paediatrics, University of Patras, Patras, Greece
| | - Nikitas Brikos
- First Department of Paediatrics, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Irini Eleftheriou
- Second Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens, Second Department of Paediatrics, Thivon and Leivadias Str, 11526 Athens, Greece
| | - Vassiliki Spoulou
- First Department of Paediatrics, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Michos
- First Department of Paediatrics, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Despoina Gkentzi
- Medical School, Department of Paediatrics, University of Patras, Patras, Greece
| | - Ekaterini Siomou
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - Vassiliki Papaevangelou
- Third Department of Paediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Grivea
- School of Health Sciences, Faculty of Medicine, Department of Paediatrics, University General Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - George Syrogiannopoulos
- School of Health Sciences, Faculty of Medicine, Department of Paediatrics, University General Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Emmanouil Galanakis
- School of Medicine, Department of Paediatrics, University of Crete, University General Hospital of Heraklion, Heraklion, Greece
| | | | - Maria Tsolia
- Second Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, National and Kapodistrian University of Athens, Second Department of Paediatrics, Thivon and Leivadias Str, 11526 Athens, Greece
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14
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Gkentzi D, Mhliordos K, Karatza A, Sinopidis X, Dimopoulou D, Eleftheriou E, Tsolia M, Mavridi A, Miliara E, Papaevangelou V, Vergadi E, Galanakis E, Dimitriou G, Fouzas S. The Psychological Impact of COVID-19 Admission on Families: Results from a Nationwide Sample in Greece. Children (Basel) 2022; 9:children9121933. [PMID: 36553376 PMCID: PMC9777457 DOI: 10.3390/children9121933] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
The aim of the present study was to assess the psychological impact of hospitalization during the COVID-19 pandemic on parents and their offspring. We performed a nationwide cross-sectional study in Greece based on an Internet questionnaire survey. A convenience sample of parents whose offspring had been hospitalized due to COVID-19 (including multisystem inflammatory syndrome in children, MIS-C), diagnosed with COVID-19 but not hospitalized, and hospitalized for another reason during the pandemic were enrolled. Parental stress was assessed using the Perceived Stress Scale (PSS) and the Revised Impact of Event Scale (IES-R) tools, and childhood mental wellbeing with the Children’s Revised Impact of Event 13 (CRIES-13) scale. Out of 214 received responses, stress levels were significantly higher in parents whose children had been admitted for COVID-19 or MIS-C versus those not admitted or admitted for other reasons (p < 0.001, for PSS/IES-R). Parental and childhood stress levels were correlated. In the multivariable linear regression analysis, children’s hospitalization because of COVID-19 or MIS-C, younger parental age, the existence of comorbidities, and another family member’s hospitalization because of COVID-19 were independent factors for higher stress. In light of the above, stricter hospital admission criteria for COVID-19 could be implemented, and psychological support for eventually admitted families may be beneficial.
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Affiliation(s)
- Despoina Gkentzi
- Department of Pediatrics, Medical School, University of Patras, 26504 Rio Patras, Greece
| | - Konstantinos Mhliordos
- Department of Pediatrics, Medical School, University of Patras, 26504 Rio Patras, Greece
| | - Ageliki Karatza
- Department of Pediatrics, Medical School, University of Patras, 26504 Rio Patras, Greece
| | - Xenophon Sinopidis
- Department of Pediatrics, Medical School, University of Patras, 26504 Rio Patras, Greece
| | - Dimitra Dimopoulou
- Department of Pediatrics, Second Department of Paediatrics, School of Medicine, P. and A. Kyriakou Children’s Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eirini Eleftheriou
- Department of Pediatrics, Second Department of Paediatrics, School of Medicine, P. and A. Kyriakou Children’s Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Maria Tsolia
- Department of Pediatrics, Second Department of Paediatrics, School of Medicine, P. and A. Kyriakou Children’s Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Artemis Mavridi
- Department of Pediatrics, Third Department of Paediatrics, School of Medicine, Attikon General Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Eugenia Miliara
- Department of Pediatrics, Third Department of Paediatrics, School of Medicine, Attikon General Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Vassiliki Papaevangelou
- Department of Pediatrics, Third Department of Paediatrics, School of Medicine, Attikon General Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Eleni Vergadi
- Department of Paediatrics, School of Medicine, University of Crete, 71500 Heraklion, Greece
| | - Emmanouil Galanakis
- Department of Paediatrics, School of Medicine, University of Crete, 71500 Heraklion, Greece
| | - Gabriel Dimitriou
- Department of Pediatrics, Medical School, University of Patras, 26504 Rio Patras, Greece
- Correspondence:
| | - Sotirios Fouzas
- Department of Pediatrics, Medical School, University of Patras, 26504 Rio Patras, Greece
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15
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Dimopoulou A, Yfanti A, Argyropoulos T, Evaggelou E, Dimopoulou D, Dimopoulou K, Iakomidis E, Feizidou P, Zavras N. Time between onset of symptoms and definitive treatment in children with acute appendicitis: How it affects length of hospital stay? Afr J Paediatr Surg 2022; 19:245-250. [PMID: 36018207 PMCID: PMC9615952 DOI: 10.4103/ajps.ajps_67_21] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Any delay in treatment of acute appendicitis (AA) could lead to complications increasing morbidity and length of hospital stay (LHS). The aim of this study was to determine the time interval between onset of symptoms and seeking medical attention and definitive treatment in children with AA and its impact on LHS. MATERIALS AND METHODS A prospective study was conducted from December 2017 to March 2018. All patients diagnosed with AA and who underwent surgical procedure were enrolled. A questionnaire leaflet completed by parents was used to collect clinical data and information about seeking medical attention and children's management. Time was divided into six different intervals (1-2 h, 3-6 h, 7-12 h, 13-24 h, >24 h and >48 h) to estimate the time between onset of symptoms and seeking medical attention and time between hospital admission and surgical procedure. LHS was recorded. RESULTS During the study period, 125 children were enrolled. Over half of the patients sought for medical assistance relatively soon (3-12 h) after the onset of symptoms, whereas 17.6% sought late healthcare (>24 h). The time between the medical examination and surgical procedure was <24 h in approximately 80% of the children. LHS was affected by time between onset of symptoms and seeking medical attention and time between medical examination and surgical procedure (P = 0.001 and P = 0.017, respectively). CONCLUSIONS The majority of the children with AA admitted to hospital were treated relatively soon after the onset of symptoms. However, a significant proportion of children delayed to seek medical advice and undergo appendectomy, increasing LHS.
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Affiliation(s)
- Anastasia Dimopoulou
- Department of Paediatric Surgery, "ATTIKON" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Amalia Yfanti
- Second Department of Paediatric Surgery, P. & A. Kyriakou Children's Hospital, Athens, Greece
| | | | - Eleni Evaggelou
- Department of Nursing, University of West Attica, Athens, Greece
| | - Dimitra Dimopoulou
- Second Department of Paediatrics, P. & A. Kyriakou Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Emmanouil Iakomidis
- Department of Paediatric Surgery, "ATTIKON" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Feizidou
- Department of Paediatric Intensive Care Unit, P. & A. Kyriakou Children's Hospital, Athens, Greece
| | - Nikolaos Zavras
- Department of Paediatric Surgery, "ATTIKON" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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16
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Dimopoulou D, Liaska M, Eleftheriou I, Kourkouni E, Tsolia M, Spyridis N. Favorable Outcome in Infants Hospitalized With COVID-19: Single Center Experience from Athens, Greece. Indian Pediatr 2022. [PMID: 35751373 PMCID: PMC9518936 DOI: 10.1007/s13312-022-2604-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study aims to describe the clinical characteristics and outcome of 92 infants (aged <12 months) with community-acquired coronavirus disease 2019 (COVID-19) between March, 2020 and June, 2021 at a single center in Athens. Infants with COVID-19 developed mild disease (89, 96.7%), and were infected mostly by their household contacts (74, 80.4%). Disease complications were rare, indicating that hospitalization is the result of low threshold for admission rather than disease severity.
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Affiliation(s)
- Dimitra Dimopoulou
- Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece.
| | - Marianthi Liaska
- Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
| | - Irini Eleftheriou
- Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partnership, 5 Chatzigianni Mexi str.,11528 Athens, Greece
| | - Maria Tsolia
- Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
| | - Nikos Spyridis
- Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
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17
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Dimopoulou A, Dimopoulou D, Papakonstantinou D, Moschoviti A, Dimopoulou K, Mitrogiorgou M, Kourti A, Zavras N, Foukas P, Fessatou S. Eosinophilic Gastrointestinal Diseases in Children: Prognostic Factors and Outcomes. Indian J Pediatr 2022; 89:923. [PMID: 35763215 DOI: 10.1007/s12098-022-04291-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Anastasia Dimopoulou
- Department of Pediatric Surgery, "Attikon" General University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street str, Athens, 124 62, Greece.
| | - Dimitra Dimopoulou
- Third Department of Pediatrics, "Attikon" General University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Papakonstantinou
- Third Department of Surgery, "Attikon" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Moschoviti
- Third Department of Pediatrics, "Attikon" General University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Marina Mitrogiorgou
- Third Department of Pediatrics, "Attikon" General University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Afroditi Kourti
- Third Department of Pediatrics, "Attikon" General University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Zavras
- Department of Pediatric Surgery, "Attikon" General University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini Street str, Athens, 124 62, Greece
| | - Periklis Foukas
- Second Department of Pathology, Medical School, "Attikon" General University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Smaragdi Fessatou
- Third Department of Pediatrics, "Attikon" General University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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18
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Dimopoulou K, Dimopoulou A, Koliakos N, Tzortzis A, Dimopoulou D, Zavras N. Recognizing and Managing Pancreaticopleural Fistulas in Children. J INVEST SURG 2022; 35:1704-1710. [DOI: 10.1080/08941939.2022.2103603] [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] [Indexed: 11/09/2022]
Affiliation(s)
| | - Anastasia Dimopoulou
- Department of Pediatric Surgery, “ATTIKON” General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Koliakos
- Third Department of Surgery, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Andrianos Tzortzis
- Third Department of Surgery, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Dimopoulou
- Second Department of Pediatrics, P. & A. Kyriakou Children’s Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Zavras
- Department of Pediatric Surgery, “ATTIKON” General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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19
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Dimopoulou D, Tsolia MN, Spyridis N, Maritsi DN. Immunogenicity 6 months post COVID-19 mRNA vaccination among adolescents with juvenile idiopathic arthritis on treatment with TNF inhibitors. Rheumatology (Oxford) 2022; 62:SI205-SI209. [PMID: 35788275 PMCID: PMC9278208 DOI: 10.1093/rheumatology/keac352] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/12/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Mass vaccination is the most effective strategy for controlling the COVID-19 pandemic. This study aimed to evaluate the 6-month immunogenicity after BNT162b2-COVID-19 vaccination in adolescents with JIA on TNFi treatment. METHODS This single-centre study included adolescents with JIA treated with TNFi for at least 18 months. Patients received two doses of COVID-19 vaccine (Pfizer-BioNTech) from 15 April to 15 May 2021. Quantitative measurement of IgG antibodies to SARS-CoV-2-spike-protein-1 was performed at 1, 3 and 6 months post-vaccination. RESULTS Overall, 21 adolescents with JIA in clinical remission at the time of vaccinations were enrolled. None of them discontinued TNFi/MTX treatment at the time of vaccine administration or during the follow-up period. All patients developed a sustained humoral response against SARS-CoV-2 at 1 and 3 months after vaccination (P < 0.05). The antibody levels decreased significantly at 6 months post-vaccination (P < 0.01). The type of JIA did not reveal any differences in the humoral response at 3 (P = 0.894) or 6 months post-vaccination (P = 0.72). No difference was detected upon comparison of the immunogenicity between the different treatment arms (adalimumab vs etanercept) at 3 (P = 0.387) and 6 months (P = 0.526), or TNFi monotherapy vs combined therapy (TNFi plus methotrexate) at 3 (P = 0.623) and 6 months (P = 0.885). CONCLUSIONS Although mRNA vaccines develop satisfactory immunogenicity at 1 month and 3 months post-vaccination in adolescents with JIA on TNFi, SARS-CoV-2 antibody titres decrease significantly overtime, remaining at lower levels at 6 months. Further collaborative studies are required to determine long-term immunogenicity, real duration of immune protection and the need for a booster vaccine dose.
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Affiliation(s)
- Dimitra Dimopoulou
- Correspondence to: Dimitra Dimopoulou, Second Department of Pediatrics, ‘P. & A. Kyriakou’ Children's Hospital, Thivon and Leivadias Str, 11526, Athens, Greece. E-mail:
| | - Maria N Tsolia
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, ‘P. & A. Kyriakou’ Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikos Spyridis
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, ‘P. & A. Kyriakou’ Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Despoina N Maritsi
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, ‘P. & A. Kyriakou’ Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
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20
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Ioannou P, Andrianaki AM, Dimopoulou D, Kruger-Krasagakis S, Koumaki D, Kofteridis DP, Samonis G, Krasagakis K. Clinical Characteristics of Patients with Erythema Nodosum and Risk of Relapse - a 17-Year Study. Maedica (Bucur) 2022; 17:259-263. [PMID: 36032615 PMCID: PMC9375894 DOI: 10.26574/maedica.2022.17.2.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Erythema nodosum (EN) is the most common type of septal panniculitis which causes inflammation of the subcutaneous fat, being the result of a hypersensitivity reaction to specific triggers. It usually presents with erythematous painful rounded lumps symmetrically on the anterior surface of the lower limbs. Rarely, it may occur in other areas such as thighs, neck and arms. This is a retrospective study describing a cohort of patients hospitalized in the University Hospital of Heraklion, Heraklion, Greece. The present research compares characteristics between patients with and without relapse and identifies independent factors associated with relapse. All patients with EN hospitalized during a 17-year period were included. Data regarding epidemiology, current or recent infections, symptoms, laboratory values and relapses were all recorded and evaluated. In total, 138 patients, of which 27 (19.6%) males, with a median age of 46.5 years, were evaluated. Clinical presentation involved multiple lesions in 115 (83.3%) patients, while 12 (8.7%) of them were febrile. Relapse was noted in 27 (19.6%) subjects. Multivariate logistic regression analysis showed that male gender was associated with a higher risk of relapse, while cases with multiple lesions were associated with a lower risk.
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Affiliation(s)
- Petros Ioannou
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | | | | | - Dimitra Koumaki
- Department of Dermatology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Diamantis P Kofteridis
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - George Samonis
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, Greece
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21
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Fragkou PC, De Angelis G, Menchinelli G, Can F, Garcia F, Morfin-Sherpa F, Dimopoulou D, Mack E, de Salazar A, Grossi A, Lytras T, Skevaki C. ESCMID COVID-19 guidelines: diagnostic testing for SARS-CoV-2. Clin Microbiol Infect 2022; 28:812-822. [PMID: 35218978 PMCID: PMC8863949 DOI: 10.1016/j.cmi.2022.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 02/07/2023]
Abstract
SCOPE The objective of these guidelines is to identify the most appropriate diagnostic test and/or diagnostic approach for SARS-CoV-2. The recommendations are intended to provide guidance to clinicians, clinical microbiologists, other health care personnel, and decision makers. METHODS An ESCMID COVID-19 guidelines task force was established by the ESCMID Executive Committee. A small group was established, half appointed by the chair and the remaining selected with an open call. Each panel met virtually once a week. For all decisions, a simple majority vote was used. A list of clinical questions using the PICO (population, intervention, comparison, outcome) format was developed at the beginning of the process. For each PICO, two panel members performed a literature search focusing on systematic reviews, with a third panellist involved in case of inconsistent results. Quality of evidence assessment was based on the GRADE-ADOLOPMENT (Grading of Recommendations Assessment, Development and Evaluation - adoption, adaptation, and de novo development of recommendations) approach. RECOMMENDATIONS A total of 43 PICO questions were selected that involve the following types of populations: (a) patients with signs and symptoms of COVID-19; (b) travellers, healthcare workers, and other individuals at risk for exposure to SARS-CoV-2; (c) asymptomatic individuals, and (d) close contacts of patients infected with SARS-CoV-2. The type of diagnostic test (commercial rapid nucleic acid amplification tests and rapid antigen detection), biomaterial, time since onset of symptoms/contact with an infectious case, age, disease severity, and risk of developing severe disease are also taken into consideration.
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Affiliation(s)
- Paraskevi C Fragkou
- First Department of Critical Care Medicine & Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, Athens, Greece; European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses, Basel, Switzerland
| | - Giulia De Angelis
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giulia Menchinelli
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fusun Can
- Department of Medical Microbiology, Koc University School of Medicine, Istanbul, Turkey; Koc University IsBank Research Center for Infectious Diseases (KUISCID), Istanbul, Turkey
| | - Federico Garcia
- Servicio de Microbiología Clínica, Hospital Universitario Clínico San Cecilio, Instituto de Investigación Biosanitaria, Granada, Spain; CIBER de Enfermedades Infecciosas, CIBERINFEC, ISCIII, Madrid, Spain
| | - Florence Morfin-Sherpa
- Laboratory of Virology, Institut des Agents Infectieux, National Reference Centre for Respiratory Viruses, Hospices Civils de Lyon, Université Claude Bernard Lyon1, Lyon, France
| | - Dimitra Dimopoulou
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses, Basel, Switzerland; Second Department of Paediatrics, P. and A. Kyriakou Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisabeth Mack
- Department of Hematology, Oncology and Immunology, University Hospital Giessen and Marburg Campus Marburg and Faculty of Medicine, Philipps University Marburg, Marburg, Germany
| | - Adolfo de Salazar
- Servicio de Microbiología Clínica, Hospital Universitario Clínico San Cecilio, Instituto de Investigación Biosanitaria, Granada, Spain; CIBER de Enfermedades Infecciosas, CIBERINFEC, ISCIII, Madrid, Spain
| | - Adriano Grossi
- Sezione di Igiene, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Theodore Lytras
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Chrysanthi Skevaki
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses, Basel, Switzerland; Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, German Center for Lung Research (DZL), Marburg, Germany.
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22
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Fragkou PC, Palaiodimou L, Stefanou MI, Katsanos AH, Lambadiari V, Paraskevis D, Andreadou E, Dimopoulou D, Zompola C, Ferentinos P, Vassilakopoulos TI, Kotanidou A, Sfikakis PP, Tsiodras S, Tsivgoulis G. Effects of low molecular weight heparin and fondaparinux on mortality, hemorrhagic and thrombotic complications in COVID-19 patients. Ther Adv Neurol Disord 2022; 15:17562864221099472. [PMID: 35646159 PMCID: PMC9136435 DOI: 10.1177/17562864221099472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/20/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) is associated with increased thrombosis prevalence. However, there are insufficient data supporting the appropriate anticoagulation dose in COVID-19. Objective: We aim to systematically assess the currently available data regarding the effects of different dosing regimens of low molecular weight heparin and/or fondaparinux (LMWH/F) on mortality risk as well as the risk of arterial/venous thrombotic events and hemorrhagic complications in confirmed COVID-19 cases. Design: We conducted a living systematic review and meta-analysis on the effects of different LMWH/F doses on mortality, thrombotic and hemorrhagic events in COVID-19 patients. Data Sources and Methods: MEDLINE, Scopus, Embase, Cochrane Library, Cochrane COVID-19 study register, European Union Drug Regulating Authorities Clinical Trials Database, and ClinicalTrials.gov were searched to detect observational cohort studies and randomized-controlled clinical trials (RCTs) comparing difference doses of LMWH/F among confirmed COVID-19 cases. Results: Thirty-one eligible studies (6 RCTs and 25 cohort studies) with 11,430 hospitalized patients were included. No association was found between LMWH/F and mortality during the following comparisons: (1) no LMWH/F versus any LMWH/F; (2) prophylactic versus higher than prophylactic LMWH/F; (3) prophylactic versus therapeutic LMWH/F; (4) intermediate versus therapeutic LMWH/F; and (5) lower than therapeutic versus therapeutic LMWH/F. Mortality was higher in patients receiving prophylactic versus intermediate LMWH/F (OR = 2.01; 95% CI: 1.19–3.39). However, this effect was mostly driven by observational data. No associations were detected between the intensity of LMWH/F and the risk of thrombotic and hemorrhagic events, except the lower risk for hemorrhage in patients on prophylactic compared to higher LMWH/F doses. Conclusion: The risk for all-cause mortality was higher in patients receiving prophylactic LMWH/F compared to those on an intermediate dose of LMWH/F, based on observational data. These results should be interpreted in light of the moderate quality and heterogeneity of the included studies. Registration: The study protocol has been registered in the International Prospective Register of Ongoing Systematic Reviews PROSPERO (Registration number: CRD42021229771).
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Affiliation(s)
- Paraskevi C. Fragkou
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Lina Palaiodimou
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, ‘Attikon’ University Hospital, Athens, Greece
| | - Maria Ioanna Stefanou
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, ‘Attikon’ University Hospital, Athens, Greece
| | - Aristeidis H. Katsanos
- Division of Neurology, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Vaia Lambadiari
- Second Department of Internal Medicine Research Unit and Diabetes Center, School of Medicine, National and Kapodistrian University of Athens, ‘Attikon’ University Hospital, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisabeth Andreadou
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Dimitra Dimopoulou
- Second Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, ‘Panagiotis and Aglaia Kyriakou’ Children’s Hospital, Athens, Greece
| | - Christina Zompola
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, ‘Attikon’ University Hospital, Athens, Greece
| | - Panagiotis Ferentinos
- Second Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, ‘Attikon’ University Hospital, Athens, Greece
| | - Theodoros I. Vassilakopoulos
- Third Department of Critical Care Medicine, School of Medicine, National and Kapodistrian University of Athens, Evgenideio Hospital, Athens, Greece
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine and Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Petros P. Sfikakis
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, ‘Attikon’ University Hospital, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, ‘Attikon’ University Hospital, Rimini 1, Chaidari, Athens 12462, Greece
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
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23
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Dimopoulou D, Vartzelis G, Dasoula F, Tsolia M, Maritsi D. Immunogenicity of the COVID-19 mRNA vaccine in adolescents with juvenile idiopathic arthritis on treatment with TNF inhibitors. Ann Rheum Dis 2022; 81:592-593. [PMID: 34844930 DOI: 10.1136/annrheumdis-2021-221607] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 11/16/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Dimitra Dimopoulou
- Infectious Diseases' Unit, Second Department of Paediatrics, 'P. & A. Kyriakou' Children's Hospital, National and Kapodistrian University, Athens, Greece
| | - George Vartzelis
- Second Department of Pediatrics, 'P. & A. Kyriakou' Children's Hospital, National and Kapodistrian University, Athens, Greece
| | - Foteini Dasoula
- Second Department of Pediatrics, 'P. & A. Kyriakou' Children's Hospital, National and Kapodistrian University, Athens, Greece
| | - Maria Tsolia
- Infectious Diseases' Unit, Second Department of Paediatrics, 'P. & A. Kyriakou' Children's Hospital, National and Kapodistrian University, Athens, Greece
| | - Despoina Maritsi
- Immunology and Rheumatology Unit, Second Department of Paediatrics, 'P. & A. Kyriakou' Children's Hospital, National and Kapodistrian University, Athens, Greece
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24
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Kiriakopoulos A, Dimopoulou A, Nastos C, Dimopoulou D, Dimopoulou K, Menenakos E, Zavras N. Medullary thyroid carcinoma in children: current state of the art and future perspectives. J Pediatr Endocrinol Metab 2022; 35:1-10. [PMID: 34592078 DOI: 10.1515/jpem-2021-0502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022]
Abstract
Medullary thyroid carcinoma (MTC) is a distinct type of malignant thyroid tumor in cell origin, biological behavior, and natural history. It accounts for 1.6% of all thyroid cancers and presents either sporadically or as a hereditary disease, the latter occurring as a part of multiple endocrine neoplasia (MEN) 2A and MEN2B syndromes or as a familial MTC disease with no other manifestations. The gene responsible for the hereditary form is the rearranged during transfection (RET) gene, a proto-oncogene located to human chromosome 10. Most pediatric MTC cases have been discovered after genetic testing investigations, leading to the concept of prophylactic surgery in presymptomatic patients. Therefore, the genetic status of the child, along with serum calcitonin levels and ultrasonographic findings, determine the appropriate age for prophylactic surgical intervention. Nevertheless, a diagnosis at an early stage of MTC warrants total thyroidectomy and central lymph node dissection with the addition of lateral/contralateral lymph node dissection depending on the tumor size, ultrasonographic evidence of neck disease, or calcitonin levels. Conversely, locally advanced/unresectable or metastatic MTC is primarily treated with multikinase inhibitors, while more specific RET inhibitors are being tested in clinical trials with promising results.
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Affiliation(s)
- Andreas Kiriakopoulos
- Fifth Department of Surgery, "Evgenidion Hospital", National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Anastasia Dimopoulou
- Department of Pediatric Surgery, University General Hospital "ATTIKON", National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Constantinos Nastos
- Third Department of Surgery, University General Hospital "ATTIKON", National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Dimitra Dimopoulou
- Second Department of Pediatrics, "P & A Kyriakou" Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Evangelos Menenakos
- Fifth Department of Surgery, "Evgenidion Hospital", National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Nikolaos Zavras
- Department of Pediatric Surgery, University General Hospital "ATTIKON", National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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Dimopoulou K, Dimopoulou A, Dimopoulou D, Panopoulou E, Zacharatou A, Patapis P, Zavras N. Primary Duodenal Melanoma: Challenges in Diagnosis and Management of a Rare Entity. Acta Medica (Hradec Kralove) 2022; 65:125-132. [PMID: 36942702 DOI: 10.14712/18059694.2023.2] [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] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Primary melanoma of the duodenum is an extremely rare, aggressive and life-threatening malignant neoplasm. Published data regarding the effectiveness of current treatment strategies is limited, and our knowledge relies mostly on sporadic case reports. The diagnosis of primary duodenal melanoma is challenging and is based on the patient's medical history and findings from physical examination and radiological and endoscopic imaging as well as proper and careful pathological examinations of the tumor. Despite the many advances in cancer treatment, the prognosis for patients with this type of melanoma remains extremely poor. Delayed diagnosis at advanced disease stage, the general aggressive behavior of this neoplasm, the technical difficulty in achieving complete surgical resection, along with the rich vascular and lymphatic drainage of the intestinal mucosa, all have a negative impact on patients' outcome. In the present review, we aimed to collect and summarize the currently available data in the literature regarding the pathogenesis, clinical features, diagnosis, management and long-term outcomes of this rare, malignant tumor, in order to expand knowledge of its biological behavior and investigate optimal therapeutic options for these patients. Additionally, we present our experience of a case involving a 73-year-old female with primary duodenal melanoma, who was successfully treated with complete surgical resection.
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Affiliation(s)
| | - Anastasia Dimopoulou
- Department of Paediatric Surgery, "ATTIKON" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Dimitra Dimopoulou
- Second Department of Pediatrics, P. & A. Kyriakou Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Panopoulou
- Second Department of Pathology, "ATTIKON" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Andriani Zacharatou
- Second Department of Pathology, "ATTIKON" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Paul Patapis
- Third Department of Surgery, "ATTIKON" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Zavras
- Department of Paediatric Surgery, "ATTIKON" General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Dimopoulou D, Giorgi M, Dimopoulou A, Agniadis E, Zavras N, Fessatou S, Attilakos A, Papaevangelou V. First case of peritonitis and acute pancreatitis related to Toxocara infection in a previously healthy 5-year-old boy. J Paediatr Child Health 2022; 58:184-185. [PMID: 33686718 DOI: 10.1111/jpc.15438] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Dimitra Dimopoulou
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Melpomeni Giorgi
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Dimopoulou
- Department of Pediatric Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Agniadis
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Zavras
- Department of Pediatric Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Smaragdi Fessatou
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Achilleas Attilakos
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Abstract
Τhe most promising approach of fighting COVID-19 and restraining the course of this pandemic is indisputably the universal vaccination of the population with safe and effective vaccines. However, besides the common and usually mild side effects of the authorized vaccines, some rare, major adverse reactions are increasingly being reported worldwide during the post marketing surveillance phase of vaccines’ circulation, such as anaphylaxis, vaccine-induced thrombotic thrombocytopenia, myopericarditis and Guillain-Barré syndrome. Despite rare cases with complications from COVID-19 vaccines, the net benefit-risk ratio shows a clearly favorable balance towards COVID-19 vaccination for all age and sex groups. Vaccine adverse events should be identified early and monitored closely. As many aspects of these adverse effects remain still obscure for the medical community and the relevant stakeholders, it is also highly important to be promptly reported. Nonetheless, these complications should not constitute a reason to change the vaccine policy and further studies are needed to alleviate concerns and reluctance to COVID-19 vaccinations. Τhe most promising approach of fighting COVID-19 is the universal, safe and effective vaccination of the population. Some rare, major adverse reactions of the authorized vaccines are increasingly being reported worldwide. Despite rare complications from COVID-19 vaccines, the benefit-risk assessment for vaccination shows a favorable balance.
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Affiliation(s)
- Paraskevi C Fragkou
- 1st Department of Critical Care and Pulmonary Services, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Dimitra Dimopoulou
- 2nd Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Children's Hospital "Panagiotis and Aglaia Kyriakou", Athens, Greece
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Papadopoulou A, Fragkou PC, Maratou E, Dimopoulou D, Kominakis A, Kokkinopoulou I, Kroupis C, Nikolaidou A, Antonakos G, Papaevangelou V, Armaganidis A, Tsantes A, Polyzogopoulou E, Tsiodras S, Antoniadou A, Moutsatsou P. Angiotensin-converting-enzyme insertion/deletion polymorphism, ACE activity, and COVID-19: A rather controversial hypothesis. A case-control study. J Med Virol 2021; 94:1050-1059. [PMID: 34708878 PMCID: PMC8661574 DOI: 10.1002/jmv.27417] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/04/2021] [Accepted: 10/20/2021] [Indexed: 01/19/2023]
Abstract
Accumulating data has shown a contribution of the renin‐angiotensin system in COVID‐19 pathogenesis. The role of angiotensin‐converting enzyme (ACE) insertion (I)/deletion (D) polymorphism as a risk factor in developing COVID‐19 disease comes from epidemiological data and is controversially discussed. We conducted a retrospective case‐control study and assessed the impact of ACE I/D genotype in COVID‐19 disease prevalence and severity. In 81 COVID‐19 patients explicitly characterized and 316 controls, recruited during the first wave of COVID‐19 pandemic, ACE I/D genotype, and ACE activity were determined. A generalized linear model was used and Poisson regression analysis estimated the risk ratios (RRs) of alleles and genotypes for disease severity. DD patients had almost 2.0‐fold increased risk (RR: 1.886, confidence limit [CL] 95%: 1.266–2.810, p = 0.0018) of developing a more severe disease when contrasted to ID and II individuals, as did D allele carriers compared to I carriers (RR: 1.372; CL 95%: 1.051–1.791; p = 0.0201). ACE activity (expressed as arbitrary units, AU/L) was lower in patients (3.62 ± 0.26) than in controls (4.65 ± 0.13) (p < 0.0001), and this reduction was observed mainly among DD patients compared to DD controls (3.97 ± 0.29 vs. 5.38 ± 0.21; p = 0.0014). Our results demonstrate that ACE DD genotype may predispose to COVID‐19 increased disease severity via a mechanism associated, at least in part, with the significant fall in their ACE activity. Our findings suggest a more complex pattern of synergy between this polymorphism and ACE activity in COVID‐19 patients compared to healthy individuals and set the grounds for large‐scale studies assessing ACE genotype‐based optimized therapies with ACE inhibitors and angiotensin receptor blockers.
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Affiliation(s)
- Anna Papadopoulou
- Department of Clinical Biochemistry, University General Hospital "ATTIKO," National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Paraskevi C Fragkou
- Fourth Department of Internal Medicine, University General Hospital "ATTIKO," National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Eirini Maratou
- Department of Clinical Biochemistry, University General Hospital "ATTIKO," National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dimitra Dimopoulou
- Third Department of Pediatrics, University General Hospital "ATTIKO," National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Antonis Kominakis
- Department of Animal Science and Aquaculture, Agricultural University of Athens, Athens, Greece
| | - Ioanna Kokkinopoulou
- Department of Clinical Biochemistry, University General Hospital "ATTIKO," National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Christos Kroupis
- Department of Clinical Biochemistry, University General Hospital "ATTIKO," National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Athina Nikolaidou
- Department of Clinical Biochemistry, University General Hospital "ATTIKO," National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgios Antonakos
- Department of Clinical Biochemistry, University General Hospital "ATTIKO," National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Vasiliki Papaevangelou
- Third Department of Pediatrics, University General Hospital "ATTIKO," National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Apostolos Armaganidis
- Second Department of Critical Care, "Attikon" University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Argirios Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Eftychia Polyzogopoulou
- Department of Emergency Medicine, "Attiko" Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, University General Hospital "ATTIKO," National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Anastasia Antoniadou
- Fourth Department of Internal Medicine, University General Hospital "ATTIKO," National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Paraskevi Moutsatsou
- Department of Clinical Biochemistry, University General Hospital "ATTIKO," National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Dimopoulou D, Spyridis N, Vartzelis G, Tsolia MN, Maritsi DN. Safety and tolerability of the COVID-19 mRNA-vaccine in adolescents with juvenile idiopathic arthritis on treatment with TNF-inhibitors. Arthritis Rheumatol 2021; 74:365-366. [PMID: 34492161 PMCID: PMC8653078 DOI: 10.1002/art.41977] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Dimitra Dimopoulou
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
| | - Nikos Spyridis
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
| | - George Vartzelis
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
| | - Maria N Tsolia
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
| | - Despoina N Maritsi
- Infectious Diseases, Immunology and Rheumatology Unit, Second Department of Paediatrics, National and Kapodistrian University of Athens, School of Medicine, 'P. and A. Kyriakou' Children's Hospital, Athens, Greece
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Affiliation(s)
- Irini Eleftheriou
- From the 2nd Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), Children's Hospital "P.& A. Kyriakou," Athens, Greece
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Eleftheriou I, Dasoula F, Dimopoulou D, Lebessi E, Serafi E, Spyridis N, Tsolia M. Real-life evaluation of a COVID-19 rapid antigen detection test in hospitalized children. J Med Virol 2021; 93:6040-6044. [PMID: 34156112 PMCID: PMC8427014 DOI: 10.1002/jmv.27149] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/19/2021] [Indexed: 12/21/2022]
Abstract
Rapid antigen detection (RAD) tests for the detection of SARS-CoV-2 are simpler, faster, and less expensive than the reverse-transcription polymerase chain reaction (RT-PCR) that is currently considered the gold standard for the diagnosis of coronavirus disease 2019 (COVID-19). The objective of this study was to determine the performance of the PANBIO COVID-19 Ag RAD (Abbott) test, a lateral flow immunoassay that detects the nucleocapsid protein, using as a reference RT-PCR method the Cobas®8800 System (Roche Diagnostics). This prospective study was conducted in a tertiary Children's Hospital and included individuals aged ≤16 years with COVID-19-related symptoms or epidemiological criteria for COVID-19. Two nasopharyngeal samples were collected to perform the PANBIO RAD test and RT-PCR. Of 744 children included, 51 (6.86%) had a positive RT-PCR result. The RAD test detected 42 of 51 PCR-positive children while there were no false-positive results. The overall sensitivity and specificity were 82.35% (95% CI, 71.9%-92.8%) and 100%, respectively. Sensitivity was >95% in symptomatic children. The assay performed poorly in asymptomatically infected children. In agreement with previous studies in adults, the PANBIO RAD test can be useful in screening for COVID-19 in children admitted with symptoms suggestive of the disease, especially in the first days of the illness.
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Affiliation(s)
- Irini Eleftheriou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, Athens, Greece
| | - Foteini Dasoula
- Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, Athens, Greece
| | - Dimitra Dimopoulou
- Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, Athens, Greece
| | - Evangelia Lebessi
- Department of Microbiology, "P. and A. Kyriakou" Children's Hospital, Athens, Greece
| | | | - Nikos Spyridis
- Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, Athens, Greece
| | - Maria Tsolia
- Second Department of Pediatrics, National and Kapodistrian University of Athens, "P. and A. Kyriakou" Children's Hospital, Athens, Greece
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Dimopoulou D, Vourli S, Douros K, Pournaras S, Papaevangelou V. Use of point-of-care molecular tests reduces hospitalization and oseltamivir administration in children presenting with influenza-like illness. J Med Virol 2021; 93:3944-3948. [PMID: 32965697 DOI: 10.1002/jmv.26538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/01/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 01/15/2023]
Abstract
Influenza is associated with increased morbidity, healthcare costs, hospitalization rates, and mortality in children. Rapid immunochromatography assay (ICA), a test with low sensitivity, is often used as point-of-care (POC) test. Recently, the rapid syndromic molecular test FilmArray has become available. This observational study aims to evaluate whether the use of FilmArray would decrease the use of antivirals and hospitalization rates among children presenting to the emergency room (ER) with influenza-like illness (ILI) symptoms. Nasopharyngeal swabs were prospectively collected from children, aged 0-16 years, presenting with ILI at the ER of a tertiary hospital during the peak endemic period. Patients were allocated to be tested by either FilmArray or ICA. The use of antivirals and hospitalization rates were noted. Logistic regression models were used to investigate the impact of testing methods on decision-making. Overall, 80 children were included (mean age: 5 years). Admissions were more likely to occur if an ICA test was performed (OR, 3.16; 95% CI, 1.01-9.82; p = .046). Oseltamivir administration was more likely among children who had undergone the ICA test (OR, 4.67; 95% CI, 1.06-20.43; p = .041). The implementation of rapid molecular test had no impact on complementary diagnostic testing or antibacterial prescription. The use of FilmArray significantly reduced both hospitalization and oseltamivir administration in children. Further knowledge on the use of POC tests is required to improve current management of children presenting with ILI and decrease associated healthcare costs.
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Affiliation(s)
- Dimitra Dimopoulou
- Third Department of Pediatrics, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Vourli
- Laboratory of Microbiology, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Douros
- Third Department of Pediatrics, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Pournaras
- Laboratory of Microbiology, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, ATTIKON University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Dimopoulou D, Dimopoulou A, Kontos F, Fessatou S, Proikas K, Agniadis E, Zavras N, Attilakos A, Papaevangelou V. Mycobacterium marseillense lymphadenitis: A newly identified strain in the pediatric population. Infect Dis Now 2021; 51:684-685. [PMID: 33798729 DOI: 10.1016/j.idnow.2021.03.008] [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: 03/08/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Dimitra Dimopoulou
- Third department of pediatrics, Attikon University General Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12642 Athens, Greece.
| | - Anastasia Dimopoulou
- Department of pediatric surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Fanourios Kontos
- Laboratory of microbiology, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Smaragdi Fessatou
- Third department of pediatrics, Attikon University General Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12642 Athens, Greece
| | - Konstantinos Proikas
- Second ENT department, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios Agniadis
- Third department of pediatrics, Attikon University General Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12642 Athens, Greece
| | - Nikolaos Zavras
- Department of pediatric surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Achilleas Attilakos
- Third department of pediatrics, Attikon University General Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12642 Athens, Greece
| | - Vassiliki Papaevangelou
- Third department of pediatrics, Attikon University General Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12642 Athens, Greece
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Dimopoulou D, Lyra V, Dimopoulou A, Papaevangelou V, Fessatou S. Is Hepatobiliary Scintigraphy Sufficient to Diagnose Rotor Syndrome in a 3-Year-Old Boy? J Nucl Med Technol 2021; 49:193-194. [PMID: 33722924 DOI: 10.2967/jnmt.120.257618] [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: 09/27/2020] [Accepted: 01/27/2021] [Indexed: 11/16/2022] Open
Abstract
Rotor syndrome (RS) is a benign, inherited, commonly misdiagnosed cause of conjugated hyperbilirubinemia whose identification prevents unnecessary invasive investigations. We present the case of a 3-y-old boy with phenotypic and laboratory findings of RS but negative genetic test results, whose diagnosis was confirmed by hepatobiliary scintigraphy.
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Affiliation(s)
- Dimitra Dimopoulou
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Lyra
- Nuclear Medicine Department, Children's Hospital of Athens "Agia Sofia," Athens, Greece; and
| | - Anastasia Dimopoulou
- Department of Paediatric Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Smaragdi Fessatou
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Laskari K, Tektonidou MG, Katsiari C, Athanassiou P, Dimopoulou D, Gerodimos C, Salamaliki C, Papagoras C, Settas L, Vassilopoulos D, Voulgari PV, Zakalka M, Georgiadis A, Gkoni G, Daoussis D, Dimitroulas T, Iliou C, Kallitsakis I, Grika EP, Mavragani C, Pikazis D, Raftakis J, Sarikoudis T, Kougkas N, Soukera D, Theodorou E, Tsatsani P, Tsiakou E, Vlachoyiannopoulos P, Vosvotekas G, Sfikakis PP. Outcome of refractory to conventional and/or biologic treatment adult Still's disease following canakinumab treatment: Countrywide data in 50 patients. Semin Arthritis Rheum 2020; 51:137-143. [PMID: 33383289 DOI: 10.1016/j.semarthrit.2020.10.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 07/14/2020] [Revised: 09/23/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of the IL-1b inhibitor canakinumab in all adults with refractory Still's disease identified from the National Organization For Medicines for off-label drug use. METHODS In a retrospective longitudinal multicenter cohort of 50 patients (median age 39 years) with active Still's disease despite treatment with corticosteroids (n = 11), conventional and synthetic (n = 34) and/or biologic disease modifying anti-rheumatic drugs (n = 30), we assessed the efficacy of canakinumab 150-300 mg administered every 4 (n = 47) or 8 weeks (n = 3) as combination therapy or monotherapy (n = 7) during a median follow-up of 27 (3-84) months. RESULTS Α complete response was initially observed in 78% of patients within 3 months (median), irrespective of age at disease onset. A partial response was evident in 20%. One patient had resistant disease. Treatment de-escalation was attempted in 15 of 39 complete responders and a complete drug discontinuation in 21 patients for 8 months (median). Eleven patients (22%) relapsed during treatment, one during de-escalation process, and 11 after treatment discontinuation. Overall, 9 of 11 relapses were successfully treated with canakinumab treatment intensification or re-introduction. At last visit, 18% of patients were off treatment due to remission and 26% due to disease activity. Canakinumab had a significant corticosteroid sparing effect allowing weaning in 21 of 41 cases. Infections (20%, severe 4%) and leucopenia (6%) led to treatment cessation in one patient. CONCLUSION High rates of sustained remission were observed in this, largest so far, real-life cohort of adult patients with refractory Still's disease treated with canakinumab.
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Affiliation(s)
- K Laskari
- Joint Rheumatology Program, NKUA Medical School, Athens, Greece.
| | - M G Tektonidou
- Joint Rheumatology Program, NKUA Medical School, Athens, Greece
| | - C Katsiari
- Dept. of Rheumatology, Thessaly University, Larissa, Greece
| | - P Athanassiou
- Dept. of Rheumatology, St. Paul's Hospital, Thessaloniki, Greece
| | - D Dimopoulou
- 4th Dept. of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | | | - C Salamaliki
- Dept. of Rheumatology, University of Patras, Patras
| | - C Papagoras
- 1st Dept. of Internal Medicine, Democritus University of Thrace, Alexandroupolis
| | - L Settas
- First Dept. of Internal Medicine, Rheumatology Section, Aristotle University, Thessaloniki, Greece
| | - D Vassilopoulos
- Joint Rheumatology Program, NKUA Medical School, Athens, Greece
| | - P V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, University of Ioannina, Ioannina, Greece
| | - M Zakalka
- First Dept. of Internal Medicine, Rheumatology Section, Aristotle University, Thessaloniki, Greece
| | | | - G Gkoni
- Rheumatologist, Metropolitan Hospital, Athens, Greece
| | - D Daoussis
- Dept. of Rheumatology, University of Patras, Patras
| | - T Dimitroulas
- 4th Dept. of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - C Iliou
- Private rheumatologist, Kozani, Greece
| | | | - E P Grika
- Rheumatology Clinic, Evangelismos Hospital, Athens, Greece
| | - C Mavragani
- Joint Rheumatology Program, NKUA Medical School, Athens, Greece
| | - D Pikazis
- Joint Rheumatology Program, NKUA Medical School, Athens, Greece
| | - J Raftakis
- Rheumatology Clinic, Asklepion Hospital, Athens, Greece
| | | | - N Kougkas
- Dept. of Rheumatology, Clinical Immunology and Allergy, University of Crete, Heraklion, Greece
| | - D Soukera
- Private rheumatologist, Corinth, Greece
| | - E Theodorou
- Dept. of Rheumatology, 251 Air Force General Hospital, Athens, Greece
| | - P Tsatsani
- Dept. of Rheumatology, KAT General Hospital, Athens, Greece
| | - E Tsiakou
- Private rheumatologist, Patras, Greece
| | | | | | - P P Sfikakis
- Joint Rheumatology Program, NKUA Medical School, Athens, Greece
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Dimopoulou D, Koutsaki M, Giorgi M, Spanou M, Dinopoulos A, Papaevangelou V. Effects of measles-containing vaccination in children with severe underlying neurologic disease. Vaccine 2020; 39:1481-1484. [PMID: 33280857 DOI: 10.1016/j.vaccine.2020.11.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/02/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Measles outbreaks pose significant risk for those unvaccinated. PATIENTS AND METHODS Measles-containing vaccine was offered to unvaccinated children with severe neurologic diseases during a measles outbreak. Vaccination adverse events were reported by parents 30 days following vaccination. Long term effects were evaluated 12 months post vaccination. RESULTS Twenty-seven children were vaccinated (36 doses given). Half of parents (51.8%) reported no adverse events following immunization. Adverse events included afebrile seizures (6/36), fever alone (5/36) and febrile seizures (5/36). Two children required hospitalization. Quadrivalent measles-containing vaccine combined with varicella was associated with febrile seizures (p = 0.04). No child needed adjustment of the anti-epileptic treatment or exhibited developmental regression. CONCLUSION Ina series of children with prior severe neurologic disease, the safety-tolerability profile ofvaccines containing a measles vaccine component suggests that vaccination is justified. Main side effect was seizure aggravation in children with known epileptic disease.
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Affiliation(s)
- Dimitra Dimopoulou
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Koutsaki
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Melpomeni Giorgi
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Spanou
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Argirios Dinopoulos
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
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Dimopoulou D, Dimopoulou A, Fessatou S, Zavras N, Papaevangelou V. Perianal Abscess With Stellate Lacerations in a 3.5-year-old Previously Healthy Boy. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-2044-y] [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: 10/23/2022]
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Dimopoulou D, Dimopoulou A, Fessatou S, Zavras N, Papaevangelou V. Perianal Abscess With Stellate Lacerations in a 3.5-year-old Previously Healthy Boy. Indian Pediatr 2020; 57:1078-1079. [PMID: 33231182] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Dimitra Dimopoulou
- Third Department of Pediatrics, Attikon University Hospital, Athens, Greece.
| | - Anastasia Dimopoulou
- Department of Pediatric Surgery, Attikon University General Hospital, Athens, Greece
| | - Smaragdi Fessatou
- Third Department of Pediatrics, Attikon University Hospital, Athens, Greece
| | - Nikolaos Zavras
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Dimopoulou D, Triantafyllidou P, Daskalaki A, Syridou G, Papaevangelou V. Breastfeeding during the novel coronavirus (COVID-19) pandemic: guidelines and challenges. J Matern Fetal Neonatal Med 2020; 35:3776-3782. [PMID: 33161802 DOI: 10.1080/14767058.2020.1838481] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
COVID-19 pandemic has raised questions on pregnant women and newborns' management. Guidelines, issued by most international agencies and national bodies, recommend rooming-in and direct breastfeeding. In the early days of this pandemic, breastfeeding practices have been challenged by fear among both parents and healthcare workers occasionally resulting in mother-newborn separation. We herein review current breastfeeding guidelines and discuss remaining questions and challenges. As we are facing the second wave of this pandemic, more information is gathered, especially regarding possible virus transmissibility through breastfeeding, enabling more definite instructions about breastfeeding practices.
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Affiliation(s)
- Dimitra Dimopoulou
- Pediatric Infectious Diseases Department, Third Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Pinelopi Triantafyllidou
- Neonatal Department, Third Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Daskalaki
- Neonatal Department, Third Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Garyfallia Syridou
- Pediatric Infectious Diseases Department, Third Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Papaevangelou
- Pediatric Infectious Diseases Department, Third Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
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Chew NWS, Ngiam JN, Tan BYQ, Tham SM, Tan CYS, Jing M, Sagayanathan R, Chen JT, Wong LYH, Ahmad A, Khan FA, Marmin M, Hassan FB, Sharon TML, Lim CH, Mohaini MIB, Danuaji R, Nguyen TH, Tsivgoulis G, Tsiodras S, Fragkou PC, Dimopoulou D, Sharma AK, Shah K, Patel B, Sharma S, Komalkumar RN, Meenakshi RV, Talati S, Teoh HL, Ho CS, Ho RC, Sharma VK. Asian-Pacific perspective on the psychological well-being of healthcare workers during the evolution of the COVID-19 pandemic. BJPsych Open 2020; 6:e116. [PMID: 33028449 PMCID: PMC7542327 DOI: 10.1192/bjo.2020.98] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers. AIMS In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes. METHOD From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country. RESULTS A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries. CONCLUSIONS This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.
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Affiliation(s)
- Nicholas W S Chew
- Department of Medicine, National University Health System, Singapore
| | | | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore; and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore,Singapore
| | - Sai-Meng Tham
- Department of Medicine, National University Health System, Singapore
| | | | - Mingxue Jing
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | | | - Jin Tao Chen
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Lily Y H Wong
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Aftab Ahmad
- Department of Neurology, Ng Teng Fong General Hospital, Singapore
| | - Faheem Ahmed Khan
- Department of Intensive Care Medicine, Ng Teng Fong General Hospital, Singapore
| | - Maznah Marmin
- Department of Neurology, Ng Teng Fong General Hospital, Singapore
| | | | | | | | | | | | - Thang H Nguyen
- Cerebrovascular Disease Department, 115 People's Hospital, Vietnam
| | - Georgios Tsivgoulis
- Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Sotirios Tsiodras
- Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Paraskevi C Fragkou
- Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | - Dimitra Dimopoulou
- Attikon University Hospital, National and Kapodistrian University of Athens, Greece
| | | | | | | | | | | | | | - Shikha Talati
- Department of Psychiatry, Geetanjali Medical College and Hospital, India
| | - Hock Luen Teoh
- Division of Neurology, Department of Medicine, National University Health System, Singapore; and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cyrus S Ho
- Department of Psychological Medicine, National University of Singapore, Singapore
| | - Roger C Ho
- Department of Psychological Medicine and Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
| | - Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Health System, Singapore; and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Dimopoulou D, Kourlaba G, Antoniadou A, Mariolis L, Kavatha D, Stoungioti S, Kekkou K, Dinopoulos A, Alexopoulou E, Papaevangelou V. Low birth weight and head circumference as potential biomarkers of sensorineural hearing loss in asymptomatic congenitally CMV-infected infants. J Clin Virol 2020; 129:104471. [DOI: 10.1016/j.jcv.2020.104471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/15/2020] [Accepted: 05/23/2020] [Indexed: 11/30/2022]
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Ntali S, Pantazi L, Boki K, Nikolopoulos D, Fanouriakis A, Dimopoulou D, Kallitsakis I, Papagoras C, Dania V, Emmanouilidou E, Bertsias G. FRI0543 BIRTH REGISTRY OF WOMEN WITH SYSTEMATIC LUPUS ERYTHEMATOSUSAND COURSE OF THE DISEASE DURING FIRST YEARS POST-PARTUM-THE GREEK EXPERIENCE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Pregnancy in women with SLE Systematic Lupus Erythematosus (SLE) has been related with adverse events both in the mother and the foetus.1Many studies have reported relapse of the disease during the pregnancy and post-labour, while others have not confirmed this finding.2To this end, most of these results originate from retrospective studies with patients of diverge ethnicities.Objectives:To record the Greek experience with pregnancies in mothers with SLE and their outcomes, as well as the course of the disease during first year post labor.Methods:This is a prospective, multicentre, observation study lasting three years. Women diagnosed with SLE who became pregnant consented to be monitored by their treating Rheumatologist. A structured questionnaire is used for monitoring at the beginning of pregnancy (positive pregnancy test) and at least every 3 months thereafter, depending on the course of the disease and pregnancy, until one year after childbirth.Results:A total 64 women and 81 pregnancies were recorded (1.27 pregnancies per patient). Patient’s age at conception was 32.8 ± 5.9 years (mean ± standard deviation). Thirteen patients (20.3%) had past history of nephritis. Regarding pregnancy outcomes, 62 (76.5%) pregnancies ended in live births, miscarriages during 1st, 2ndand 3rdtrimester occurred in 13 (16%). Six pregnancies were lost to followup. Prematurity occurred in 28 live births (45.1% in total), 26-32w (3.2%), 32-36w (22.5%), <37w (19.3%). No cases of preeclampsia occurred. Mean age of birth36.9 weeksand mean birth weight2750gr.The majority (72.5%) of deliveries were performed by caesarean section. In terms of disease activity, most of the women had mild disease at conception, (SLEDAI-2K: 2.67±2.69) that declined during 1st/2ndpregnancy trimester (SLEDAI-2K:1.91±2.09, 1.70±2.22)) but increased during the 1stand 2ndtrimester post labor (SLEDAI-2K: 2.47±4.29 and 2.52±3.2).Conclusion:This is the first Greek inception cohort with prospective monitoring of pregnant SLE patients. Adverse outcomes occur with prematurity being the most frequent. In our cohort disease activity tends to increase during 1stand 2ndtrimester post-labor without serious relapses. Vigilant monitoring during pregnancy and post-labour is advised.References:[1] Bundhun PK, Soogund MZ, Huang F. Impact of systemic lupus erythematosus on maternal and fetal outcomes following pregnancy: A meta-analysis of studies published between years 2001-2016. J Autoimmun 2017;79:17-27. [https://doi. org/10.1016/j.jaut.2017.02.009] [PMID: 28256367][2] Wei S, Lai K, Yang Z, Zeng K. Systemic lupus erythematosus and risk of preterm birth: a systematic review and meta-analysis of observational studies. Lupus 2017;26:563-71. [https://doi. org/10.1177/0961203316686704] [PMID: 28121241]Acknowledgments:Hellenic Rheumatology AssociationDisclosure of Interests:Stella Ntali: None declared, Lina Pantazi: None declared, Kyriaki Boki: None declared, Dionysis Nikolopoulos: None declared, Antonis Fanouriakis: None declared, Despoina Dimopoulou: None declared, Ioannis Kallitsakis Grant/research support from: MSD, Speakers bureau: Genesis pharma, Bristol-Myers Squibb, CHARALAMPOS PAPAGORAS: None declared, Vasiliki Dania: None declared, Evgenia Emmanouilidou: None declared, George Bertsias Grant/research support from: GSK, Consultant of: Novartis
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Laskari K, Athanassiou P, Georgiadis A, Gerodimos C, Gkoni G, Daoussis D, Dimitroulas T, Dimopoulou D, Iliou C, Kallitsakis I, Karamitsos D, Katsiari C, Liossis SN, Mavragani C, Papagoras C, Pikazis D, Raftakis I, Sarikoudis T, Settas L, Sidiropoulos P, Soukera D, Theodorou E, Tsatsani P, Tsiakou E, Vassilopoulos D, Vlachoyiannopoulos P, Vosvotekas G, Voulgari PV, Zakalka M, Tektonidou M, Sfikakis P. FRI0493 THE INTERLEUKIN-1B INHIBITOR CANAKINUMAB FOR REFRACTORY STILL’S DISEASE: LONG-TERM EXPERIENCE IN 50 CONSECUTIVE PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Interleukin-1 (IL-1) is a major mediator of the inflammatory cascade in Still’s disease and an established therapeutic target.Objectives:To assess the efficacy and safety of the IL-1b inhibitor canakinumab in adolescent and adult patients with refractory Still’s disease.Methods:We conducted a retrospective longitudinal outcome study of 50 consecutive patients aged 39 years (median, range 14-72), fulfilling the Yamaguchi disease classification criteria, with active disease despite treatment with corticosteroids (CS) (n=11) and/or methotrexate (n=9) and/or biologics (n=30) [tumor necrosis factor inhibitors (n=13), IL-6 blockade (n=7), abatacept (n=2), anakinra (n=24); ≥1 biologics (n=13)]. Canakinumab 150-300 mg was administered sc, starting every 4 (n=48) or 8 weeks (n=2), for a median of 24 months (range 3-84). Concomitant treatment included CS (n=41), methotrexate (n=12) and leflunomide (n=3).Results:Complete remission was initially achieved in 78% of patients within a median time of 3 months, irrespective of age at disease onset. Partial clinical and laboratory response was evident in 20%. Canakinumab was discontinued in one patient with resistant disease (primary failure) and in 6 out of 10 initial responders, who relapsed during treatment (secondary failure). Of 39 patients in complete remission, increase in drug administration interval and/or drug dose reduction was attempted in 7, of which only 1 relapsed, whereas drug discontinuation was attempted in 19 patients for a median time of 8 months (range 3-68), of which 8 relapsed. Overall, in half of all disease flares, canakinumab re-introduction or intensification was successful. Canakinumab had a significant CS sparing effect permitting weaning in 21 of 41 cases. Infections (20%, severe 4%) and leucopenia (6%) led to treatment cessation in one patient.Conclusion:In this largest so far real-life patient cohort with refractory Still’s disease, high rates of sustained remission were induced by canakinumab both in adolescent and adult patients.Disclosure of Interests:Katerina Laskari: None declared, Panagiotis Athanassiou Grant/research support from: MSD, Genesis pharma, Janssen, Consultant of: Roche, Genesis pharma, Janssen, Speakers bureau: MSD, Janssen, Roche, Genesis pharma, Athanasios Georgiadis: None declared, Charalampos Gerodimos: None declared, Georgia Gkoni: None declared, Dimitrios Daoussis: None declared, Theodoros Dimitroulas: None declared, Despoina Dimopoulou: None declared, Chrysoula Iliou: None declared, Ioannis Kallitsakis Grant/research support from: MSD, Speakers bureau: Genesis pharma, Bristol-Myers Squibb, Dimitrios Karamitsos: None declared, Christina Katsiari: None declared, Stamatis-Nick Liossis: None declared, Clio Mavragani: None declared, CHARALAMPOS PAPAGORAS: None declared, Dimitrios Pikazis: None declared, Ioannis Raftakis: None declared, Theodosios Sarikoudis: None declared, Loukas Settas: None declared, Prodromos Sidiropoulos: None declared, Despoina Soukera: None declared, Evangelos Theodorou: None declared, Panagiota Tsatsani: None declared, Eleni Tsiakou: None declared, Dimitrios Vassilopoulos: None declared, PANAYIOTIS VLACHOYIANNOPOULOS: None declared, Georgios Vosvotekas: None declared, Paraskevi V. Voulgari: None declared, Marina Zakalka: None declared, Maria Tektonidou Grant/research support from: AbbVie, MSD, Novartis and Pfizer, Consultant of: AbbVie, MSD, Novartis and Pfizer, Petros Sfikakis Grant/research support from: Grant/research support from Abvie, Novartis, MSD, Actelion, Amgen, Pfizer, Janssen Pharmaceutical, UCB
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Kyriakopoulou A, Serghiou S, Dimopoulou D, Arista I, Psaltopoulou T, Dinopoulos A, Papaevangelou V. Antenatal imaging and clinical outcome in congenital CMV infection: A field-wide systematic review and meta-analysis. J Infect 2020; 80:407-418. [PMID: 32097687 DOI: 10.1016/j.jinf.2020.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/09/2019] [Revised: 02/08/2020] [Accepted: 02/12/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Postnatal outcome in fetuses with congenital cytomegalovirus infection (cCMV) varies from asymptomatic infection to severe neurodevelopmental impairment. Αntenatal biomarkers of long-term clinical outcome, have yet to be established. Α systematic review and meta-analysis was performed to examine whether prenatal cerebral ultrasonography (US) and magnetic resonance imaging (MRI) findings in cCMV fetuses may predict clinical outcome. METHODS PubMed and the Web of Science were systematically searched to identify studies reporting on any prenatal US and/or MRI imaging of fetuses with cCMV as well as their postnatal clinical outcome. All reported associations between imaging and postnatal clinical outcome were systematically extracted. Where appropriate, the reported associations were quantitatively synthesized within Bayesian random-effects meta-analyses. RESULTS A total of 1336 studies were screened to identify 26 eligible observational studies. Overall, 4181 fetuses were studied, of which 1518 had been diagnosed with cCMV. All studies performed fetal US while in 14 (54%) MRI was also performed. Studies substantially varied in timing of fetal imaging, reporting of abnormalities, definition of poor outcome and statistical analysis. Among studies reporting on statistical significance, 6/6 for US and 3/4 for MRI identified significant associations between imaging findings and outcome. In our meta-analyses, within isolated abnormalities, only microcephaly had greater than 95% probability of being associated with poor outcome (OR 26.7; 95% CI, 1.44-1464.5; I2, 19%). Effect sizes for US were higher than those for MRI findings. CONCLUSIONS Although studies displayed significant heterogeneity in both methodology and analytical decisions, it became evident that when both prenatal cerebral US and MRI are normal the negative predictive value of poor outcome is high. This is important for clinicians when consulting pregnant women. Need to standardize practices and definitions become evident. FUNDING There was no source of funding.
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Affiliation(s)
- Aikaterini Kyriakopoulou
- Third Department of Paediatrics, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 115 27, Greece.
| | - Stylianos Serghiou
- Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford University, Stanford, CA, United States; Meta-Research Innovation Center at Stanford, Stanford University, Stanford, CA, United States
| | - Dimitra Dimopoulou
- Third Department of Paediatrics, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 115 27, Greece
| | - Ioli Arista
- Health Economist, Independent Researcher, Athens, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens 115 27, Greece
| | - Argyrios Dinopoulos
- Third Department of Paediatrics, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 115 27, Greece
| | - Vassiliki Papaevangelou
- Third Department of Paediatrics, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens 115 27, Greece
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Sakellaris G, Dimopoulou D, Niniraki M, Dimopoulou A, Alegakis A, Symvoulakis EK, Kostaki D, Blevrakis E, Kolivaki S, Chryssos E. The role of blood inflammatory markers in the diagnosis of appendicitis in children: a prospective study from a University Hospital in Greece. Gazz Med Ital - Arch Sci Med 2020. [DOI: 10.23736/s0393-3660.18.03636-7] [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: 11/08/2022]
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Dimopoulou A, Zavras N, Alexopoulou E, Fessatou S, Dimopoulou D, Attilakos A. Superior mesenteric artery syndrome mimicking cyclic vomiting syndrome in a healthy 12-year-old boy. J Paediatr Child Health 2020; 56:168-170. [PMID: 31408239 DOI: 10.1111/jpc.14592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/26/2019] [Accepted: 07/28/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Anastasia Dimopoulou
- Department of Paediatric Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Zavras
- Department of Paediatric Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthymia Alexopoulou
- Department of Radiology, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Smaragdi Fessatou
- Third Department of Paediatrics, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Dimopoulou
- Third Department of Paediatrics, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Achilleas Attilakos
- Third Department of Paediatrics, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Kekkou K, Kavatha D, Karalexi M, Galani L, Dimopoulou D, Papaevangelou V, Antoniadou A. Risk of congenital cytomegalovirus infection in children born to women with IgG avidity in the grey zone during first trimester of pregnancy. J Matern Fetal Neonatal Med 2019; 34:2025-2029. [PMID: 31401915 DOI: 10.1080/14767058.2019.1651277] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Cytomegalovirus (CMV) is the most common congenital viral infection and is regarded as the leading nongenetic cause of sensorineural hearing loss. Currently, international consensuses discourage prenatal screening of pregnant women. However, in few countries mainly in Southern Europe, screening of pregnant women for CMV infection is common practice. Management of women found with IgG+/IgM + and IgG avidity titers in the grey zone during first trimester causes significant stress to both families and health care workers. PATIENTS AND METHODS Pregnant women referred to our outpatient clinic with the diagnosis of acute CMV infection (IgM+/IgG+) during early pregnancy (gestational age ≤ 14 weeks) and IgG avidity in the grey zone were prospectively followed. The administration of CMV-HIG was offered and follow-up included fetal U/S, amniocentesis for CMV-DNA detection and MRI when appropriate. All neonates were examined by urine PCR and prospectively followed according to existing recommendations. RESULTS Ninety women (mean age 30.8 years) were retrospectively analyzed. Most (79.6%) received CMV-HIG. Four women terminated pregnancy (2 unrelated to CMV reasons and 2 because of CMV-positive amniotic fluid). Eighty-seven babies were born asymptomatic. Two newborns were diagnosed with congenital CMV infection. The overall transmission rate was 4.4%; 4.3 versus 5.6% for those receiving or not CMV-HIG. No adverse outcomes were detected during follow-up (median 24 months). Maternal age, parity, detection of maternal CMV-viremia upon diagnosis, delay between diagnosis and consultation, gestational week of first consultation, administration of CMV-HIG and number of doses were not associated with the risk of vertical CMV transmission. DISCUSSIONS Vertical transmission of CMV infection in pregnancies with acute CMV-infection and IgG avidity titers in the grey zone during first trimester was 4.4%, higher than that in infants born post nonprimary infection (NPI) during pregnancy. More powered studies are needed to prove a significant reduction in transmission using CMV-HIG.
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Affiliation(s)
- Kassiani Kekkou
- Third Department of Pediatrics, General University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Kavatha
- Fourth Department of Internal Medicine, General University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Karalexi
- Third Department of Pediatrics, General University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
| | - Lamprini Galani
- Fourth Department of Internal Medicine, General University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Dimopoulou
- Third Department of Pediatrics, General University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, General University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Antoniadou
- Fourth Department of Internal Medicine, General University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
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Dimopoulou D, Tsagris V, Georgaki I, Karalexi M, Dimopoulou A, Papaevangelou V, Attilakos A. Afebrile Kawasaki disease in infants. Minerva Pediatr (Torino) 2019. [PMID: 31271275 DOI: 10.23736/s0026-4946.19.05589-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Dimitra Dimopoulou
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece -
| | - Vasileios Tsagris
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Georgaki
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Karalexi
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Dimopoulou
- Department of Pediatric Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Achilleas Attilakos
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Dimopoulou D, Tsagris V, Georgaki I, Karalexi M, Dimopoulou A, Papaevangelou V, Attilakos A. Afebrile Kawasaki disease in infants. Minerva Pediatr (Torino) 2019; 73:283-285. [PMID: 31271275 DOI: 10.23736/s2724-5276.19.05589-0] [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] [Indexed: 11/08/2022]
Affiliation(s)
- Dimitra Dimopoulou
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece -
| | - Vasileios Tsagris
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Georgaki
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Karalexi
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Dimopoulou
- Department of Pediatric Surgery, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Achilleas Attilakos
- Third Department of Pediatrics, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Papakonstantinou PE, Samonis G, Andrianaki AM, Christofaki M, Dimopoulou D, Papadakis J, Gikas A, Kofteridis DP. Epidemiology, Microbiological and Clinical Features, Treatment, and Outcomes of Infective Endocarditis in Crete, Greece. Infect Chemother 2018; 50:21-28. [PMID: 29637749 PMCID: PMC5895827 DOI: 10.3947/ic.2018.50.1.21] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/17/2018] [Indexed: 02/06/2023] Open
Abstract
Background This study aimed to evaluate the epidemiology, clinical and microbiological features, treatment, and outcomes of infective endocarditis (IE) on the island of Crete, a region with high levels of antimicrobial resistance. Materials and Methods Medical records of all hospitalized patients diagnosed with IE at the University Hospital of Heraklion, Crete, Greece, from 1995 to 2015, were retrospectively reviewed. Patients who met the modified Duke's criteria for definite or possible IE were included. Results A total of 82 IE patients (median age 67 [range 21–86] years) were included. Most patients suffered from left-sided IE (94%), while most cases of infection occurred in native valves (53.6%). Systemic inflammatory response syndrome criteria were lacking in almost half of the patient population. The leading causative microorganism was Staphylococcus aureus, isolated in 24 cases (29%), followed by Streptococcus spp. in 15 (18%) and Enterococcus spp. in 12 (14.5%). A number of rare and difficult to treat microorganisms had been identified, such as Gemella morbillorum in four cases (4.5%), Streptococcus lugdunensis in two (2.5%) and Streptococcus pneumoniae in one (1%). One patient was serologically positive for Coxiella burnetii (1%). All patients received empirical antimicrobial treatment, proven appropriate in 39 blood culture-positive patients (56.5%). Thirteen (16%) patients were classified as culture negative. Seven patients (8.5%) were surgically treated. In-hospital death occurred in 9 patients (11%). Conclusion Changes in IE profile requires continuous epidemiological updates. Staphylococcus and Streptococcus spp. remain the most common etiologic agents. However, the presence of uncommon and/or difficult to treat pathogens raise concerns on the appropriate prophylaxis as well as empirical treatment.
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Affiliation(s)
- Panteleimon E Papakonstantinou
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - George Samonis
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Angeliki M Andrianaki
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Maria Christofaki
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Dimitra Dimopoulou
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - John Papadakis
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Achilleas Gikas
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Diamantis P Kofteridis
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece.
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