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Koulenti D, Paramythiotou E, Almyroudi MP, Karvouniaris M, Markou N, Paranos P, Routsi C, Meletiadis J, Blot S. Severe mold fungal infections in critically ill patients with COVID-19. Future Microbiol 2024. [PMID: 38700287 DOI: 10.2217/fmb-2023-0261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
The SARS-CoV-2 pandemic put an unprecedented strain on modern societies and healthcare systems. A significantly higher incidence of invasive fungal co-infections was noted compared with the pre-COVID-19 era, adding new diagnostic and therapeutic challenges in the critical care setting. In the current narrative review, we focus on invasive mold infections caused by Aspergillus and Mucor species in critically ill COVID-19 patients. We discuss up-to-date information on the incidence, pathogenesis, diagnosis and treatment of these mold-COVID-19 co-infections, as well as recommendations on preventive and prophylactic interventions. Traditional risk factors were often not recognized in COVID-19-associated aspergillosis and mucormycosis, highlighting the role of other determinant risk factors. The associated patient outcomes were worse compared with COVID-19 patients without mold co-infection.
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Affiliation(s)
- Despoina Koulenti
- Department of Critical Care Medicine, King's College Hospital NHS Foundation Trust, London, UK
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | - Maria Panagiota Almyroudi
- Emergency Department, Attikon University Hospital, National & Kapodistrian University of Athens, Greece
| | | | - Nikolaos Markou
- Intensive Care Unit of Latseio Burns Centre, Thriasio General Hospital of Elefsina, Greece
| | - Paschalis Paranos
- Clinical Microbiology Laboratory, Attikon University Hospital, National & Kapodistrian Uni-versity of Athens, Greece
| | - Christina Routsi
- First Department of Intensive Care, School of Medicine, National & Kapodistrian University of Athens, Evangelismos General Hospital, Athens, Greece
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Attikon University Hospital, National & Kapodistrian Uni-versity of Athens, Greece
| | - Stijn Blot
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Internal Medicine & Pediatrics, Ghent University, Ghent, Belgium
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Sykara M, Ntovas P, Markou N, Madianos P, Vassilopoulos S. Individualized digitally designed surgical template for guided soft tissue surgery in cases with severe gingival enlargement: A clinical application in hereditary gingival fibromatosis. Int J Comput Dent 2024; 27:99-107. [PMID: 38530272 DOI: 10.3290/j.ijcd.b5004083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
AIM The purpose of this study was to present the use of computer-assisted periodontal surgery utilizing a novel surgical guide for cases with severe gingival enlargement through a clinical application in a patient with hereditary gingival fibromatosis. MATERIALS AND METHODS The treatment plan included nonsurgical periodontal therapy, surgical periodontal treatment, and regular periodontal maintenance before the initiation of orthodontic treatment. Due to the increased soft tissue thickness, a surgical guide with a novel design was fabricated to facilitate the periodontal surgery since most of the patient's teeth were malpositioned and underexposed due to fibromatosis. For this purpose, the patient's intraoral scan was merged with a CBCT image in order to plan surgical excisions based on the anatomy of the teeth and the bone contour. RESULTS The customized surgical guide facilitated the gingivectomy by controlling not only the shape of the initial incisions but also their orientation toward the level of the cementoenamel junction, improving the efficiency of the clinical time compared with freehand surgery and assisting in the verification of the final soft tissue shape, based on the treatment plan. CONCLUSION Digital technology through the superimposition of multiple data sets can assist in the diagnosis and multidisciplinary management of cases with gingival fibromatosis. The proposed design of the surgical guide can facilitate soft tissue surgery based on the digital treatment plan, leading to more predictable management of the soft tissue, especially in patients with severe gingival enlargement, as in cases with hereditary gingival fibromatosis or drug-induced gingival overgrowth.
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Markou N, Pepelassi E, Madianos P, Simopoulou M, Karoussis IK. Systemic inflammatory markers following adjunctive Nd:YAG (1064 nm) laser irradiation to step 2 of periodontal therapy: a 12-month, randomized, controlled trial. Clin Oral Investig 2023; 27:6925-6935. [PMID: 37816915 DOI: 10.1007/s00784-023-05309-3] [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: 07/21/2023] [Accepted: 10/03/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVES The aim of this study was to investigate whether the use of adjunctive Nd:YAG (1064 nm) laser irradiation to full-mouth scaling and root planing (FM-SRP) may offer additional benefit in the systemic inflammatory status of the patient, as depicted in a variety of systemic biomarkers over FM-SRP alone, up to 12 months after treatment. MATERIALS AND METHODS A total of 60 otherwise healthy stage III/IV periodontal patients were equally distributed in 3 groups. The control group received FM-SRP. In laser A group, 1 week after FM-SRP, Nd:YAG laser irradiation was delivered in periodontal pockets with PD ≥ 4 mm using specific settings (3 W, 150 mJ, 20 Hz, 100 μs). In laser B group Nd:YAG laser irradiation was delivered twice, 1 week after FM-SRP and 1 week later with different settings compared to laser A (2 W, 200 mJ, 10 Hz, 100 μs). RESULTS A significant reduction (p = 0.038) of IL-1β serum levels at the 6-month time point was observed for laser A group. IL-6 was found statistically significantly increased (p = 0.011) in the control group at the 6-week time point, whereas no difference was reported for the laser-treated groups (laser A, laser B). CONCLUSIONS The adjunctive use of Nd:YAG laser irradiation, prevented from IL-6 increase after FM-SRP, 6 weeks after treatment. Similarly, Nd:YAG laser irradiation (3 W, 150 mJ, 20 Hz,100 μs) was associated with significantly lower IL-1β levels, 6 months post-operatively. CLINICAL RELEVANCE Additional Nd:YAG laser application to FM-SRP may provide a potential beneficial effect on systemic inflammation. TRIAL REGISTRATION NUMBER ISRCTN26692900. REGISTRATION DATE 09/06/2022.
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Affiliation(s)
- Nikolaos Markou
- Department of Periodontology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
- Department of Periodontology, 401 Athens Military Hospital, Athens, Greece.
| | - Eudoxie Pepelassi
- Department of Periodontology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Phoebus Madianos
- Department of Periodontology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Mara Simopoulou
- Department of Physiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis K Karoussis
- Department of Periodontology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Markou N, Pepelassi E, Madianos P, Simopoulou M, Karoussis IK. Correction to: Systemic inflammatory markers following adjunctive Nd:YAG (1064 nm) laser irradiation to step 2 of periodontal therapy: a 12‑month, randomized, controlled trial. Clin Oral Investig 2023; 27:6937. [PMID: 37855922 DOI: 10.1007/s00784-023-05340-4] [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: 10/20/2023]
Affiliation(s)
- Nikolaos Markou
- Department of Periodontology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
- Department of Periodontology, 401 Athens Military Hospital, Athens, Greece.
| | - Eudoxie Pepelassi
- Department of Periodontology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Phoebus Madianos
- Department of Periodontology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Mara Simopoulou
- Department of Physiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis K Karoussis
- Department of Periodontology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Koulenti D, Karvouniaris M, Paramythiotou E, Koliakos N, Markou N, Paranos P, Meletiadis J, Blot S. Severe Candida infections in critically ill patients with COVID-19. J Intensive Med 2023; 3:291-297. [PMID: 38028641 PMCID: PMC10658040 DOI: 10.1016/j.jointm.2023.07.005] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/20/2023] [Accepted: 07/09/2023] [Indexed: 12/01/2023]
Abstract
The frequency of co-infections with bacterial or fungal pathogens has constantly increased among critically ill patients with coronavirus disease 2019 (COVID-19) during the pandemic. Candidemia was the most frequently reported invasive fungal co-infection. The onset of candidemia in COVID-19 patients was often delayed compared to non-COVID-19 patients. Additionally, Candida invasive infections in COVID-19 patients were more often linked to invasive procedures (e.g., invasive mechanical ventilation or renal replacement therapy) during the intensive care stay and the severity of illness rather than more "classic" risk factors present in patients without COVID-19 (e.g., underlying diseases and prior hospitalization). Moreover, apart from the increased incidence of candidemia during the pandemic, a worrying rise in fluconazole-resistant strains was reported, including a rise in the multidrug-resistant Candida auris. Regarding outcomes, the development of invasive Candida co-infection had a negative impact, increasing morbidity and mortality compared to non-co-infected COVID-19 patients. In this narrative review, we present and critically discuss information on the diagnosis and management of invasive fungal infections caused by Candida spp. in critically ill COVID-19 patients.
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Affiliation(s)
- Despoina Koulenti
- Second Critical Care Department, Attikon University Hospital, Athens, Greece
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | | | - Nikolaos Koliakos
- Second Critical Care Department, Attikon University Hospital, Athens, Greece
| | - Nikolaos Markou
- ICU of Latseio Burns Centre, General Hospital of Elefsis ‘Thriasio’, Athens, Greece
| | - Paschalis Paranos
- Clinical Microbiology Laboratory, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Stijn Blot
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
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Karakike E, Dalekos GN, Koutsodimitropoulos I, Saridaki M, Pourzitaki C, Papathanakos G, Kotsaki A, Chalvatzis S, Dimakopoulou V, Vechlidis N, Paramythiotou E, Avgoustou C, Ioakeimidou A, Kouriannidi E, Komnos A, Neou E, Rovina N, Stefanatou E, Milionis H, Nikolaidis G, Koutsoukou A, Damoraki G, Dimopoulos G, Zoumpos V, Eugen-Olsen J, Akinosoglou K, Gatselis NK, Koulouras V, Gkeka E, Markou N, Netea MG, Giamarellos-Bourboulis EJ. ESCAPE: An Open-Label Trial of Personalized Immunotherapy in Critically lll COVID-19 Patients. J Innate Immun 2021; 14:218-228. [PMID: 34852352 PMCID: PMC8805059 DOI: 10.1159/000519090] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 04/09/2021] [Accepted: 08/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Macrophage activation-like syndrome (MALS) and complex immune dysregulation (CID) often underlie acute respiratory distress (ARDS) in COVID-19. We aimed to investigate the effect of personalized immunotherapy on clinical improvement of critical COVID-19. Methods In this open-label prospective trial, 102 patients with ARDS by SARS-CoV-2 were screened for MALS (ferritin >4,420 ng/mL) and CID (ferritin ≤4,420 ng/mL and low human leukocyte antigen (HLA)-DR expression on CD14-monocytes). Patients with MALS or CID with increased aminotransferases received intravenous anakinra; those with CID and normal aminotransferases received tocilizumab. The primary outcome was ≥25% decrease in the Sequential Organ Failure Assessment (SOFA) score and/or 50% increase in the respiratory ratio by day 8; 28-day mortality, change of SOFA score by day 28, serum biomarkers, and cytokine production by mononuclear cells were secondary endpoints. Results The primary study endpoint was met in 58.3% of anakinra-treated patients and in 33.3% of tocilizumab-treated patients (p: 0.01). Most patients in both groups received dexamethasone as standard of care. No differences were found in secondary outcomes, mortality, and SOFA score changes. Ferritin decreased among anakinra-treated patients; interleukin-6, soluble urokinase plasminogen activator receptor, and HLA-DR expression increased among tocilizumab-treated patients. Survivors by day 28 who received anakinra were distributed to lower severity levels of the WHO clinical progression scale. Greater incidence of secondary infections was found with tocilizumab treatment. Conclusion Immune assessment resulted in favorable anakinra responses among critically ill patients with COVID-19 and features of MALS.
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Affiliation(s)
- Eleni Karakike
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | | | - Maria Saridaki
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Chryssa Pourzitaki
- Intensive Care Unit, AHEPA Thessaloniki General Hospital, Thessaloniki, Greece
| | - Georgios Papathanakos
- Department of Critical Care Medicine, University of Ioannina, School of Health Sciences, Faculty of Medicine, Ioannina, Greece
| | - Antigone Kotsaki
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Stamatios Chalvatzis
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Nikolaos Vechlidis
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Elisabeth Paramythiotou
- Second Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Christina Avgoustou
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | - Elli Kouriannidi
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Apostolos Komnos
- Intensive Care Unit, Koutlimpaneion-Triantafylleion Larissa General Hospital, Larissa, Greece
| | - Evangelia Neou
- Intensive Care Unit, Koutlimpaneion-Triantafylleion Larissa General Hospital, Larissa, Greece
| | - Nikoletta Rovina
- First Department of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Eleni Stefanatou
- Intensive Care Unit of Latseion Burn Center, General Hospital of Eleusis Thriasion, Eleusis, Greece
| | - Haralampos Milionis
- First Department of Internal Medicine, University of Ioannina, School of Health Sciences, Faculty of Medicine, Ioannina, Greece
| | | | - Antonia Koutsoukou
- First Department of Pulmonary Medicine and Intensive Care Unit, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgia Damoraki
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - George Dimopoulos
- Second Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Vassileios Zoumpos
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Karolina Akinosoglou
- Department of Internal Medicine, University of Patras, Medical School, Rion, Greece
| | - Nikolaos K Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
| | - Vasilios Koulouras
- Department of Critical Care Medicine, University of Ioannina, School of Health Sciences, Faculty of Medicine, Ioannina, Greece
| | - Eleni Gkeka
- Intensive Care Unit, AHEPA Thessaloniki General Hospital, Thessaloniki, Greece
| | - Nikolaos Markou
- Intensive Care Unit of Latseion Burn Center, General Hospital of Eleusis Thriasion, Eleusis, Greece
| | - Mihai G Netea
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University, Nijmegen, The Netherlands.,Immunology and Metabolism, Life & Medical Sciences Institute, University of Bonn, Bonn, Germany
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Halvatsiotis P, Kotanidou A, Tzannis K, Jahaj E, Magira E, Theodorakopoulou M, Konstandopoulou G, Gkeka E, Pourzitaki C, Kapravelos N, Papoti S, Sileli M, Gogos C, Velissaris D, Markou N, Stefanatou E, Vlachogianni G, Aimoniotou E, Komnos A, Zafeiridis T, Koulouvaris P, Armaganidis A, Bamias A, Dimopoulos G. Demographic and clinical features of critically ill patients with COVID-19 in Greece: The burden of diabetes and obesity. Diabetes Res Clin Pract 2020; 166:108331. [PMID: 32682810 PMCID: PMC7366091 DOI: 10.1016/j.diabres.2020.108331] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 01/08/2023]
Abstract
AIMS The aim of the study was to investigate the association between type-2 diabetes mellitus, other underlying diseases and obesity with the outcomes of critically ill Covid-19 patients in Greece. METHODS In this retrospective observational multi-centre study, data and outcomes of 90 RNA 2109-nCoV confirmed critically ill patients from 8 hospitals throughout Greece, were analysed. All reported information stand through April 13th 2020. RESULTS The median age of the patients was 65.5 (IQR 56-73), majority were male (80%) and obesity was present in 34.4% of patients most prevalent to younger than 55 years. Hypertension was the prevailing comorbidity (50%), followed by cardiovascular diseases (21.1%) and type-2 diabetes (18.9%). At admission, common symptoms duration had a median of 8 (IQR 5-11) days. A 13.3% of the patients were discharged, 53.4% were still in the ICUs and 28.9% deceased who were hospitalised for fewer days than the survivors [6 (IQR 3-9) vs. 9 (IQR 7-14.5) respectively]. Aging was not a risk factor but diabetes deteriorates the outcomes. Obesity poses a suggestive burden as it was more notable in deceased versus survivors. CONCLUSIONS Type 2 diabetes and obesity may have contributed to disease severity and mortality in COVID-19 critically ill patients in Greece.
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Affiliation(s)
- P Halvatsiotis
- 2nd Propaedeutic Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Rimini 1, Chaidari 124 62, Greece.
| | - A Kotanidou
- 1st Department of Critical Care, Medical School of National and Kapodistrian University of Athens, "EVANGELISMOS" General Hospital, 45-47 Ipsilantou str, 10675 Athens, Greece
| | - K Tzannis
- 2nd Propaedeutic Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Rimini 1, Chaidari 124 62, Greece
| | - E Jahaj
- 1st Department of Critical Care, Medical School of National and Kapodistrian University of Athens, "EVANGELISMOS" General Hospital, 45-47 Ipsilantou str, 10675 Athens, Greece
| | - E Magira
- 1st Department of Critical Care, Medical School of National and Kapodistrian University of Athens, "EVANGELISMOS" General Hospital, 45-47 Ipsilantou str, 10675 Athens, Greece
| | - M Theodorakopoulou
- 2nd Department of Critical Care, Medical School of National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Rimini 1, Chaidari 124 62, Greece
| | - G Konstandopoulou
- 2nd Department of Critical Care, Medical School of National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Rimini 1, Chaidari 124 62, Greece
| | - E Gkeka
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, School of Health Sciences of Aristotle University of Thessaloniki, AHEPA University Hospital, Kyriakidi 1, Thessaloniki 54621, Greece
| | - C Pourzitaki
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, School of Health Sciences of Aristotle University of Thessaloniki, AHEPA University Hospital, Kyriakidi 1, Thessaloniki 54621, Greece
| | - N Kapravelos
- 2nd Critical Care Department, General Hospital of Thessaloniki "G. PAPANIKOLAOU" Leof. Papanikolaou, Pilaia Chortiatis 57011, Greece
| | - S Papoti
- 2nd Critical Care Department, General Hospital of Thessaloniki "G. PAPANIKOLAOU" Leof. Papanikolaou, Pilaia Chortiatis 57011, Greece
| | - M Sileli
- 2nd Critical Care Department, General Hospital of Thessaloniki "G. PAPANIKOLAOU" Leof. Papanikolaou, Pilaia Chortiatis 57011, Greece
| | - C Gogos
- Emergency Department and Department of Internal Medicine of Patras University, Medical School, University Hospital of Patras, Rio, Patras 26504, Greece.
| | - D Velissaris
- Emergency Department and Department of Internal Medicine of Patras University, Medical School, University Hospital of Patras, Rio, Patras 26504, Greece
| | - N Markou
- LATSION Burn Center - Intensive Care Unit, General Hospital of Eleusis "THRIASSIO", Leof G Gennimata, Elefsina 19600, Greece
| | - E Stefanatou
- LATSION Burn Center - Intensive Care Unit, General Hospital of Eleusis "THRIASSIO", Leof G Gennimata, Elefsina 19600, Greece
| | - G Vlachogianni
- Department of Critical Care, AGIOS DIMITRIOS General Hospital of Thessaloniki, Elenis Zografou 2, Thessaloniki 54634, Greece.
| | - E Aimoniotou
- Department of Critical Care, AGIOS DIMITRIOS General Hospital of Thessaloniki, Elenis Zografou 2, Thessaloniki 54634, Greece
| | - A Komnos
- Department of Critical Care, General Hospital of Larisa "KOUTLIMPANIO", Tsakalof 1, Larisa 41221, Greece
| | - T Zafeiridis
- Department of Critical Care, General Hospital of Larisa "KOUTLIMPANIO", Tsakalof 1, Larisa 41221, Greece
| | - P Koulouvaris
- 1st Department of Orthopaedics, Medical School of National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Rimini 1, Chaidari 124 62, Greece.
| | - A Armaganidis
- 2nd Department of Critical Care, Medical School of National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Rimini 1, Chaidari 124 62, Greece.
| | - A Bamias
- 2nd Propaedeutic Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Rimini 1, Chaidari 124 62, Greece.
| | - G Dimopoulos
- 2nd Department of Critical Care, Medical School of National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Rimini 1, Chaidari 124 62, Greece.
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Orbegozo D, Mongkolpun W, Stringari G, Markou N, Creteur J, Vincent JL, De Backer D. Skin microcirculatory reactivity assessed using a thermal challenge is decreased in patients with circulatory shock and associated with outcome. Ann Intensive Care 2018; 8:60. [PMID: 29725778 PMCID: PMC5934288 DOI: 10.1186/s13613-018-0393-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 10/27/2017] [Accepted: 04/12/2018] [Indexed: 11/24/2022] Open
Abstract
Background Shock states are characterized by impaired tissue perfusion and microcirculatory alterations, which are directly related to outcome. Skin perfusion can be noninvasively evaluated using skin laser Doppler (SLD), which, when coupled with a local thermal challenge, may provide a measure of microcirculatory reactivity. We hypothesized that this microvascular reactivity would be impaired in patients with circulatory shock and would be a marker of severity. Methods We first evaluated skin blood flow (SBF) using SLD on the forearm and on the palm in 18 healthy volunteers to select the site with maximal response. Measurements were taken at 37 °C (baseline) and repeated at 43 °C. The 43 °C/37 °C SBF ratio was calculated as a measure of microvascular reactivity. We then evaluated the SBF in 29 patients with circulatory shock admitted to a 35-bed department of intensive care and in a confirmatory cohort of 35 patients with circulatory shock. Results In the volunteers, baseline SBF was higher in the hand than in the forearm, but the SBF ratio was lower (11.2 [9.4–13.4] vs. 2.0 [1.7–2.6], p < 0.01) so we used the forearm for our patients. Baseline forearm SBF was similar in patients with shock and healthy volunteers, but the SBF ratio was markedly lower in the patients (2.6 [2.0–3.6] vs. 11.2 [9.4–13.4], p < 0.01). Shock survivors had a higher SBF ratio than non-survivors (3.2 [2.2–6.2] vs. 2.3 [1.7–2.8], p < 0.01). These results were confirmed in the second cohort of 35 patients. In multivariable analysis, the APACHE II score and the SBF ratio were independently associated with mortality. Conclusions Microcirculatory reactivity is decreased in patients with circulatory shock and has prognostic value. This simple, noninvasive test could help in monitoring the peripheral microcirculation in acutely ill patients. Electronic supplementary material The online version of this article (10.1186/s13613-018-0393-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Diego Orbegozo
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Wasineenart Mongkolpun
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Gianni Stringari
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Nikolaos Markou
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Jacques Creteur
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
| | - Daniel De Backer
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
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Grigorakos L, Markou N, Lazarescu D, Tzortzopoulou K, Gkouni M, Papaioannou E, Bikou M, Moles A. Effective Management Of Patients With Amniotic Fluid Embolism In The Intensive Care Unit: Two Case Reports. Int Arch Med 2017. [DOI: 10.3823/2527] [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: 11/09/2022] Open
Abstract
Amniotic Fluid Embolism (AFE) is a rare complication of the intra- and early post-partum period, which may also be encountered with cesarean delivery and during abortions. Its symptompatology includes respiratory distress with cyanosis, shock and possibly tonic-clonic seizures. Disseminated intravascular coagulation (DIC) frequently occurs and is usually fatal. The aim of this case report is to present the positive outcome and our gained experience from two cases suffering from AFE. Thus, we analyze the case of two patients, in the second trimester of pregnancy who presented symptoms of AFE. Our study reveals that in the case of patients with AFE, early diagnosis, prompt management and proper treatment increase survival rate and may ensure complete recovery in a relatively short period of time. However, DIC is a serious aggravating factor which makes the recovery process slower.
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Grigorakos L, Sgountzos V, Lazarescu D, Simopoulou S, Gkouni M, Markou N, Tamvakis V. Primary thoracic muscle tuberculosis: two case reports. J Med Case Rep 2016; 10:229. [PMID: 27531321 PMCID: PMC4988048 DOI: 10.1186/s13256-016-0996-2] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/06/2016] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this case report is to present our experience with two very rare cases of thoracic muscle tuberculosis. Muscle tuberculosis, as a primary disease, can only be detected in cases in which mycobacteria have been transplanted to a muscle through an infected needle. Case presentations Case 1 is a 38-year-old immigrant man and Case 2 is a 24-year-old immigrant man, both originating from Sub-Saharan African Countries; they presented in the past two years to our hospital with swellings at the base of the hemithorax and were diagnosed as having muscle tuberculosis. Administration of anti-tuberculosis chemotherapy caused: (a) diminution of inflammation, (b) diminution of the size of local fusiform injury, and (c) clinical improvement. Conclusions Thoracic muscle tuberculosis should be considered to be one of the etiologies of muscular disease in European countries with a high incidence of immigrants originating from endemic geographical areas.
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Affiliation(s)
- Leonidas Grigorakos
- Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece. .,Intensive Care, General Trauma and Accident Hospital of Athens KAT, Athens, Greece.
| | | | - Daria Lazarescu
- Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Simopoulou
- Peripheral Anticancer Oncology Hospital of Athens "Agios Savvas", Athens, Greece
| | | | - Nikolaos Markou
- Intensive Care at Latseion Burn Center, Thriasio General Hospital, Elefsina, Greece
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Markou N, Fousteri M, Markantonis SL, Zidianakis B, Hroni D, Boutzouka E, Baltopoulos G. Colistin pharmacokinetics in intensive care unit patients on continuous venovenous haemodiafiltration: an observational study. J Antimicrob Chemother 2012; 67:2459-62. [PMID: 22790220 DOI: 10.1093/jac/dks257] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Available data on colistin pharmacokinetics in patients undergoing continuous renal replacement therapy (CRRT) are limited. Our aim was to study colistin pharmacokinetics in critically ill patients treated with colistin methane sulphonate for Gram-negative sepsis and undergoing continuous venovenous haemodiafiltration for acute renal failure. PATIENTS AND METHODS Three patients were studied. The colistin methane sulphonate dose administered was at the discretion of the attending physician and was in all cases lower than that recommended for individuals with intact renal function. Colistin methane sulphonate was administered intravenously over 30 min, and blood samples were collected from each patient pre- and post-filter for the HPLC determination of colistin levels in serum before infusion, at 10, 60, 120, 240, 360, 480 and 600 min from the end of infusion, and immediately before the next dose. Concurrently, spot samples of effluent from the haemofilter were also collected and analysed. Both colistin total extracorporeal clearance and clearance in the effluent were calculated. RESULTS Extracorporeal clearance resulted in substantial removal of colistin (43%-59% of total colistin clearance). Total colistin clearance was found to be reduced (varying between 3.3 and 4.5 L/h), compared with patients with normal renal function. Colistin methane sulphonate dosage resulted in clearly suboptimal colistin steady-state concentrations. CONCLUSIONS In spite of substantial extracorporeal clearance, total colistin clearance was reduced, compared with patients with normal renal function. Colistin adsorption by the haemofilter contributed to its extracorporeal clearance to a large extent. Studies on other patients receiving colistin methane sulphonate and undergoing CRRT are required before more appropriate dosage regimens can be recommended.
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Affiliation(s)
- Nikolaos Markou
- ICU, Latsion Burn Center, Thriasion Hospital, Athens, Greece.
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Stefanatou E, Kompoti M, Paridou A, Koutsodimitropoulos I, Giannopoulou P, Markou N, Kalofonou M, Trikka-Graphakos E, Tsidemiadou F. Probiotic sepsis due to Saccharomyces fungaemia in a critically ill burn patient. Mycoses 2011; 54:e643-6. [PMID: 21672040 DOI: 10.1111/j.1439-0507.2010.01963.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Markou N, Fousteri M, Markantonis SL, Boutzouka E, Tsigou E, Baltopoulo G. Colistin Penetration in the Alveolar Lining Fluid of Critically Ill Patients Treated With IV Colistimethate Sodium. Chest 2011; 139:232-3; author reply 233-4. [DOI: 10.1378/chest.10-1860] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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14
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Markou N, Pepelassi E, Vavouraki H, Stamatakis HC, Nikolopoulos G, Vrotsos I, Tsiklakis K. Treatment of periodontal endosseous defects with platelet-rich plasma alone or in combination with demineralized freeze-dried bone allograft: a comparative clinical trial. J Periodontol 2010; 80:1911-9. [PMID: 19961374 DOI: 10.1902/jop.2009.090216] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Platelet-rich plasma (PRP) alone or combined with other regenerative materials was previously studied in human periodontal endosseous defects. There are no sufficient data evaluating to what extent the addition of demineralized freeze-dried bone allograft (DFDBA) to PRP may enhance the effectiveness of PRP. The aim of this randomized, double-masked, controlled clinical trial was to compare the effectiveness of autologous PRP alone to PRP + DFDBA in periodontal endosseous defects. METHODS Twenty-four proximal endosseous defects in 24 patients with severe chronic periodontitis were randomly treated with PRP alone or in combination with DFDBA. The final evaluation at 6 months was based on clinical and radiographic parameters. Subtraction radiography was used. The primary outcome variable was clinical attachment level (CAL). RESULTS The two treatment groups were initially comparable (mean CAL: 8.67 +/- 2.19 mm for PRP + DFDBA and 8.25 +/- 1.96 mm for PRP). Both treatments achieved statistically significant and similar CAL gain (3.08 +/- 1.17 mm for PRP + DFDBA and 3.08 +/- 0.95 mm for PRP), probing depth, defect depth, and area surface reduction. The percentage of defect fill did not significantly differ between the two treatments. There was a non-significant trend to greater defect fill (45.42% versus 41.29%), defect depth (54.05% versus 49.52%), and area surface (58.43% versus 52.16%) reduction with the graft. In both groups, 66.66% of the defects gained > or =3 mm of CAL. CONCLUSION Within its limits, this study demonstrates that both PRP and PRP combined with DFDBA resulted in significant clinical and radiographic improvement in human periodontal endosseous defects at 6 months, and the addition of DFDBA to PRP did not significantly enhance the treatment outcome.
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Affiliation(s)
- Nikolaos Markou
- Department of Periodontology, School of Dentistry, University of Athens, Athens, Greece.
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Kotsovilis S, Markou N, Pepelassi E, Nikolidakis D. The adjunctive use of platelet-rich plasma in the therapy of periodontal intraosseous defects: a systematic review. J Periodontal Res 2009; 45:428-43. [PMID: 19909404 DOI: 10.1111/j.1600-0765.2009.01236.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE The evidence for the efficacy of the adjunctive use of platelet-rich plasma (PRP) in periodontal intraosseous defects has not been systematically evaluated. The objective of this review was to address the focused question, 'What is the efficacy, with respect to clinical, radiographical and patient-centred outcomes, of combinations of PRP with other therapeutic bioactive agents/procedures, compared with the efficacy of the same agents/procedures without the adjunctive use of PRP in the therapy of periodontal intraosseous defects in patients with chronic periodontitis and without systemic diseases that could potentially influence the outcome of periodontal therapy?' by performing a systematic review of randomized controlled clinical trials (RCTs) published in the dental literature in any language, up to and including September 2008. MATERIAL AND METHODS Data sources principally included electronic databases, manually searched journals and contact with experts. In the first phase of study selection, the titles and abstracts, and in the second phase, full papers were screened independently and in duplicate by two reviewers. RESULTS In the first phase, 6124 potentially relevant titles and abstracts were examined. In the second phase, the full text of 20 publications was thoroughly evaluated. Eventually, 10 RCTs were selected. CONCLUSION Diverse outcomes (positive and negative) have been reported for the efficacy of PRP combined with various therapeutic bioactive agents/procedures, reflecting the limited and heterogeneous data available and possibly suggesting that the specific selection of agents/procedures combined with PRP could be important. Additional research on the efficacy of each specific combination of PRP is necessary.
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Affiliation(s)
- S Kotsovilis
- Department of Periodontology, School of Dentistry, University of Athens, Athens, Greece
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Grigorakos L, Sotiriou E, Markou N, Stratouli S, Boutzouka E, Philntisis G, Baltopoulos G. Combined nutritional support in patients with chronic obstructive pulmonary disease (COPD), under mechanical ventilation (MV). Hepatogastroenterology 2009; 56:1612-1614. [PMID: 20214203] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND/AIMS The importance of nutrition is clearly established in the management of the critically ill patient: malnutrition contributes to immune incompetence, poor wound healing, increased postoperative complication and prolonged hospital stay. The interaction between nutritional status, nutritional supply and respiratory function is important in the management of the Chronic Obstructive pulmonary Disease (COPD) patients under mechanical ventilation (MV). In the present study was analyzed the benefits of combined nutritional support in patients with COPD under MV. METHODOLOGY One hundred ninety two (192) patients with COPD were admitted to our Intensive Care Unit (ICU), due to severe respiratory failure of whom 163 (84.9%) patients were under MV. In 18 (11.04%) patients after the 10th day under MV and due to severe malnutrition (serum albumin < 2.5 gm/dl, total lymphocyte count (TLC) < 900/mm3), added in the enteral nutrition (EN) of 1800 Kcals and parenteral nutrition (PN) of 2000 Kcals, at high concentration in lipids from central venous catheter. RESULTS Seven (38.89%) patients on the 4th day, after combined nutrition, had a positive balance of nitrogen and normal level of the nutritional indices, 4 (22.22%) were on normal level on the 5th day, 3 (16.67%) on the 6th day, 1 (5.56%) on the 7th day after combined nutrition. We had no complications from the combination of EN and PN. Conclusively, of these 18 patients that were given both EN and PN, 15 (83.33%) were weaned from MV and continued the combined nutritional support for 3 days, while 3 (16.67%) died during the combination of EN and PN, without having achieved a normal level of the indices of nutrition and without a positive balance of nitrogen. CONCLUSIONS In this study was found that: 1. patients with COPD under MV rapidly developed malnutrition, 2. the combination EN and PN without complications contribute to the weaning from MV, 3. positive nitrogen balance and normal increases of nutrition are achieved after the 4th day of combined nutrition and 4. Early addition of EN and PN in patients with COPD under MV, probably accelerates the weaning from MV, reduces hospitalization, changes the outcome and reduces the cost of hospitalization of patients with COPD under MV in ICU.
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Affiliation(s)
- Leonidas Grigorakos
- Athens University School of Nursing, Intensive Care at Trauma, Hospital of Athens, KAT, Kifisia, Athens, Greece.
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Kompoti M, Paridou A, Stefanatou H, Iordanidou O, Koutsodimitropoulos I, Markou N, Kalofonou M, Tsidemiadou F. Incidence of infections and impact on ICU mortality of severely burned patients. Burns 2009. [DOI: 10.1016/j.burns.2009.06.160] [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: 10/20/2022]
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Gregorakos L, Markou N, Psalida V, Kanakaki M, Alexopoulou A, Sotiriou E, Damianos A, Myrianthefs P. Near-Drowning: Clinical Course of Lung Injury in Adults. Lung 2009; 187:93-7. [DOI: 10.1007/s00408-008-9132-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 11/28/2008] [Indexed: 10/21/2022]
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Markou N, Demopoulou E, Myrianthefs P. The critically ill patient with cancer - indications for Intensive Care Unit admission and outcomes. J BUON 2008; 13:469-478. [PMID: 19145667] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Critically ill cancer patients admitted to the Intensive Care Unit (ICU) have high mortality rates compared to noncancer patients. Yet, with suitable patient selection, improved ICU- and 6-month survival has been observed in these patients: admission of cancer patients to the ICU can no more be considered futile. As a general rule, patients with good performance status, who are at the initial phase of their malignant disease and with life-extending treatment options available, should be routinely admitted to the ICU, while patients being only in palliative care should not. When in doubt, an ICU trial with re-appraisal at 3-6 days may be the best policy, as the data available when ICU admission is considered, are not sufficient to identify patients who are likely to benefit from ICU management.
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Affiliation(s)
- N Markou
- Intensive Care Unit - B, KAT Hospital, Athens, Greece.
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Markou N, Athanasiou M, Hroni D, Myrianthefs P. Disorders of Respiration and Sleep-Disordered Breathing in Patients with Chronic Renal Failure. CRMR 2006. [DOI: 10.2174/157339806778777212] [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: 11/22/2022]
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Markou N, Kanakaki M, Myrianthefs P, Hadjiyanakos D, Vlassopoulos D, Damianos A, Siamopoulos K, Vasiliou M, Konstantopoulos S. Sleep-disordered breathing in nondialyzed patients with chronic renal failure. Lung 2006; 184:43-9. [PMID: 16598651 DOI: 10.1007/s00408-005-2563-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2005] [Indexed: 12/27/2022]
Abstract
The prevalence and significance of sleep-disordered breathing (SDB) in dialysis-independent chronic renal failure (CRF) remains unknown. We studied the presence of SDB in nondialyzed CRF patients. Diagnostic polysomnography was performed in consecutive stable nondialyzed CRF patients. Inclusion criteria were age <or=70 years, absence of systolic dysfunction or history of pulmonary edema, FEV(1) > 70% pr, absence of neurologic disease or hypothyroidism, and calculated creatinine clearance <40 ml/min. Thirty-five patients (19 male, 16 female) were studied. An apnea-hypopnea index (AHI) >or=5/h was present in 54.3% (almost exclusively obstructive events). AHI correlated with urea (r = 0.35, p = 0.037), age (r = 0.379, p = 0.025), and body mass index (BMI) (r = 0.351, p = 0.038), but not with creatinine clearance. AHI or SDB were unrelated to gender. In nondiabetics (n = 25), AHI correlated with urea (r = 0.608, p = 0.001) and creatinine clearance (r = -0.50, p = 0.012). Nondiabetics with severe CRF (calculated GFR < 15 ml/min/1.73 m(2)) had a significantly higher AHI compared with less severe CRF. Restless legs syndrome (RLS) was present in 37.1% and periodic limb movements in 28.6%. Daytime sleepiness was not associated with respiratory events, but was more common in patients with RLS. The prevalence of SDB and RLS is high in dialysis-independent CRF. SDB weakly correlates with indices of kidney function and this association becomes stronger in nondiabetics.
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Affiliation(s)
- Nikolaos Markou
- Department of Pulmonary Medicine, A Fleming General Hospital, 2 Pigis St., 15126, Mellisia, Athens, Greece.
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Markou N, Tsangaris I, Konstantonis D, Vretzakis G, Pneumatikos I, Katsikoyiannis N, Argiropoulou P, Prassopoulos P. Massive subcutaneous emphysema as presenting finding of colonic perforation and retroperitoneal necrotizing fasciitis. Am J Emerg Med 2005; 23:421-2. [PMID: 15915440 DOI: 10.1016/j.ajem.2005.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Markou N, Antzoulatos N, Haniotou A, Kanakaki M, Parissis J, Damianos A. A Case of Drug-Induced Pneumonitis Caused by Carvedilol. Respiration 2004; 71:650-2. [PMID: 15627880 DOI: 10.1159/000081770] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2002] [Accepted: 11/21/2003] [Indexed: 11/19/2022] Open
Abstract
We present a case of drug- induced pneumonitis caused by carvedilol. Forty days after drug cessation, there was almost complete resolution of pulmonary infiltrates. This is the first report of pneumonitis caused by carvedilol.
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Affiliation(s)
- Nikolaos Markou
- Department of Pulmonary Medicine, Melisia General Hospital A. Fleming, Athens, Greece.
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Hroni D, Athanassiou M, Koumoudiou C, Markou N, Anagnostopoulou D, Preza A, Papaspyropoulou N, Apostolakos H. Crit Care 2004; 8:P41. [DOI: 10.1186/cc2508] [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: 11/10/2022] Open
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Markou N, Grigorakos L, Myrianthefs P, Boutzouka E, Rizos M, Evagelopoulou P, Apostolakos H, Baltopoulos G. Venous pressure measurements in the superior and inferior vena cava: the influence of intra-abdominal pressure. Hepatogastroenterology 2004; 51:51-5. [PMID: 15011830] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND/AIMS To investigate the relationship of pressure in the inferior vena cava (Pivc) with a) pressure in the superior vena cava (Psvc), b) intra-abdominal pressure as measured in the urinary bladder (Pcyst). METHODOLOGY A prospective study of 38 mechanically ventilated patients. Simultaneous measurements of Psvc, Pivc and Pcyst (151 sets of measurements) were performed. Measurements were divided in: Group A (Pcyst < 10 mmHg), group B (10 mmHg < or = Pcyst < 15 mmHg), group C (Pcyst > or = 15 mmHg). Statistical analysis was performed with paired t-test, Pearson correlation. Results are expressed in mean +/- SEM. RESULTS In Groups A and B, Psvc and Pivc were not significantly different and they were highly correlated (10.8+/-0.5 mmHg vs. 10.9+/-0.5 mmHg, r=0.93 for Group A and 14.4+/-0.7 mmHg vs. 14.7+/-0.6 mmHg, r=0.87 for Group B). Pcyst was significantly lower than Pivc in both groups. In Group C, Pivc was significantly higher than Psvc (18.9+/-0.7 mmHg vs. 16.4+/-0.7 mmHg). There was no significant difference between Pivc and Pcyst (19.2+/-0.6 mmHg). Pivc significantly correlated with Pcyst (r=0.78) and Psvc (r=0.7). A. When Pcyst > Psvc, Pivc was higher than Psvc (p<0.01). With Pcyst < 15 mmHg, no significant difference was found between Pcyst and Pivc and they were correlated (r=0.766, p<0.05). Pressures in the superior and inferior vena cava were also correlated (r=0.764, p<0.05). With Pcyst > or = 15 mmHg, Pivc was lower than Pcyst (p<0.01). It correlated highly with Pcyst (r=0.85, p<0.01) and less strongly with Psvc (r=0.701, p<0.01). B. When Pcyst < or = Psvc, no difference between Pivc and Psvc was observed. With Pcyst < 15 mmHg, Pivc was higher than Pcyst (p<0.01) and highly correlated with Psvc (r=0.932, p<0.01). Pivc also correlated with Pcyst (r=0.69, p<0.01). With Pcyst > or = 15 mmHg, Pivc was higher than Pcyst (p<0.01) and correlated with Psvc (r=0.74, p<0.01) and Pcyst (r=0.789, p<0.01). CONCLUSIONS Although Psvc and Pivc are interchangeable in the absence of an increased Pcyst, when Pcyst is high, measurements of Pivc are misleading. A Pcyst > Psvc results in a "waterfall" effect, and Pivc does not accurately reflect Psvc any more.
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Affiliation(s)
- N Markou
- B ICU, KAT Hospital, Athens, Greece.
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Limberi S, Markou N, Sakayianni K, Vourliotou A, Kremastinou F, Savari E, Gregorakos L. Coronary artery disease and upper abdominal surgery: impact of anesthesia on perioperative myocardial ischemia. Hepatogastroenterology 2003; 50:1814-20. [PMID: 14696412] [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] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND/AIMS Some papers claim that epidural anesthesia and analgesia lowers the incidence of perioperative ischemic events and may have a favorable effect on perioperative cardiac morbidity and mortality. We studied the effect of epidural anesthesia and analgesia on perioperative myocardial ischemia, in a group of patients with known coronary artery disease, who underwent upper abdominal surgery. METHODOLOGY Fifty patients with coronary artery disease scheduled for elective upper abdominal surgery, were randomized to two study groups: Group A (n = 25) received general anesthesia plus epidural anesthesia and analgesia, while group B (n = 25) received general anesthesia with postoperative i.v. analgesia. All patients had Holter ECG recording from 24 hours preoperatively until 48 hours postoperatively. RESULTS Preoperatively, no significant differences in ischemic burden were observed between the two groups. Intraoperatively, significantly fewer patients in group A had ischemic episodes (8% vs. 36%, p < 0.05) and there was also a significant reduction in the number of ischemic episodes and in mean duration of ischemia per hour of monitoring. Similar findings were observed in the first 24 hours postoperatively but not later on, with 12% of patients in group A having ischemic episodes vs. 60% in group B (p < 0.01). Group A had significantly better pain control postoperatively. Only one third of ischemic episodes were related to hemodynamic abnormality, and most of them were clinically silent. No serious cardiac morbidity or mortality was observed during the period of monitoring. CONCLUSIONS Epidural anesthesia and analgesia reduces intraoperative and early postoperative ischemia in patients with known coronary artery disease undergoing upper abdominal surgery.
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Affiliation(s)
- Sotiria Limberi
- Anesthesiology Department of Ippokration General Hospital of Athens, Athens, Greece
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Bastas A, Markou N, Botsi C, Myrianthefs P, Trigidou R, Poulakis N, Polyzogopoulos D. Malakoplakia of the lung caused by Pasteurella multocida in a patient with AIDS. Scand J Infect Dis 2003; 34:536-8. [PMID: 12195882 DOI: 10.1080/003655402320208794] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We present a case of malakoplakia of the lung caused by Pasteurella multocida in a patient with AIDS. This is the first report to implicate P. multocida in the pathogenesis of malakoplakia.
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Affiliation(s)
- Antonios Bastas
- Fourth Department of Pulmonary Medicine, Athens Chest Hospital Sotiria, Athens, Greece
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Markou N, Apostolakos H, Koumoudiou C, Athanasiou M, Koutsoukou A, Alamanos I, Gregorakos L. Intravenous colistin in the treatment of sepsis from multiresistant Gram-negative bacilli in critically ill patients. Crit Care 2003; 7:R78-83. [PMID: 12974973 PMCID: PMC270720 DOI: 10.1186/cc2358] [Citation(s) in RCA: 199] [Impact Index Per Article: 9.5] [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: 05/01/2003] [Revised: 07/07/2003] [Accepted: 07/08/2003] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The increasing prevalence of multiresistant Gram-negative strains in intensive care units (ICUs) has recently rekindled interest in colistin, a bactericidal antibiotic that was used in the 1960s for treatment of infections caused by Gram-negative bacilli. We conducted the present observational study to evaluate the efficacy of intravenous colistin in the treatment of critically ill patients with sepsis caused by Gram-negative bacilli resistant to all other antibiotics. PATIENTS AND METHOD Critically ill patients with sepsis caused by Gram-negative bacilli resistant to all antibiotics with the exception of colistin were treated in the six-bed ICU of a trauma hospital. Diagnosis of infection was based on clinical data and isolation of bacteria, and the bacteria were tested with respect to their susceptibility to colistin. Clinical response to colistin was evaluated. RESULTS Twenty-four patients (mean age 44.3 years, mean Acute Physiology and Chronic Health Evaluation II score 20.6) received 26 courses of colistin. Clinical response was observed for 73% of the treatments. Survival at 30 days was 57.7%. Deterioration in renal function was observed in 14.3% of 21 patients who were not already receiving renal replacement therapy, but in only one case did this deterioration have serious clinical consequences. CONCLUSION The lack of a control group in the present study does not allow any definite conclusions to be drawn regarding the clinical effectiveness of colistin. On the other hand, this drug has an acceptable safety profile and its use should be considered in severe infections with multiresistant Gram-negative bacilli.
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Affiliation(s)
- Nikolaos Markou
- Intensive Care Unit B, Athens Trauma Hospital KAT, Athens, Greece.
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Markou N, Myrianthefs P, Boutzouka E, Rizos M, Hroni D, Evagelopoulou P, Apostolakos H, Baltopoulos G. Crit Care 2003; 7:P180. [DOI: 10.1186/cc2069] [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: 11/10/2022] Open
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Gregorakos L, Myrianthefs P, Markou N, Chroni D, Sakagianni E. Severity of illness and outcome in adult patients with primary varicella pneumonia. Respiration 2002; 69:330-4. [PMID: 12169746 DOI: 10.1159/000063274] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Varicella pneumonia is a serious complication of primary varicella infection in adults that often results in respiratory failure and death. OBJECTIVE To analyze the clinical and laboratory manifestations of primary varicella pneumonia in patients admitted to our intensive care unit (ICU). METHODS Retrospective study on patients treated in our ICU with a diagnosis of primary varicella pneumonia during a period of 15 years. We recorded age, gender, smoking habits, clinical and laboratory findings, arterial blood gases, chest radiograph, illness severity (SAPS II), length of stay, necessity for mechanical ventilation, complications, therapy and survival. We examined the influence of the duration of respiratory symptoms and rash prior to admission, and the influence of illness severity on outcome. RESULTS There was a statistically significant difference in duration of respiratory symptoms, duration of rash and SAPS II on admission between: (a) mechanically ventilated patients vs. spontaneously breathing patients (p < 0.007, p < 0.00, p < 0.00), (b) patients who survived vs. patients with poor outcome (p < 0.001, p < 0.000, p < 0.000), and (c) mechanically ventilated patients with poor outcome vs. mechanically ventilated patients who survived (p < 0.001, p < 0.00, p < 0.000). Overall mortality was 13.6%; death occurred only in mechanically ventilated patients (mortality 33.3%). CONCLUSIONS Primary varicella pneumonia remains a critical problem with significant mortality. When recognized before respiratory failure ensues and mechanical ventilation becomes mandatory, patients could have an excellent outcome. Adult patients who delay asking for medical support, the disease may lead to the need for mechanical ventilation and severe complications with a fatal outcome.
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Affiliation(s)
- Leonidas Gregorakos
- Athens University School of Nursing, Intensive Care Unit at Trauma Hospital of Athens, Kifisia, Athens, Greece.
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Markou N, Malamos P, Hroni D, Alamanos I, Damianos A, Apostolakos H. Crit Care 2002; 6:P82. [DOI: 10.1186/cc1786] [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: 11/10/2022] Open
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Markou N, Myrianthefs P, Malamos P, Ilieskou B, Alamanos I, Paulou E, Gregorakos L, Apostolakos H. Crit Care 2002; 6:P23. [DOI: 10.1186/cc1696] [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: 11/10/2022] Open
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Markou N, Myrianthefs P, Boutzouka E, Rizos M, Apostolakos C, Baltopoulos G. Relationship between superior (PSVC), inferior (PIVC) vena cava and bladder (PCYST) pressure. Crit Care 2001. [PMCID: PMC3333331 DOI: 10.1186/cc1211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gregorakos L, Sakayianni K, Hroni D, Harizopoulou V, Markou N, Georgiadou F, Adamidou M. Prolonged coma due to cerebral fat embolism: report of two cases. J Accid Emerg Med 2000; 17:144-6. [PMID: 10718245 PMCID: PMC1725339 DOI: 10.1136/emj.17.2.144] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Fat embolism syndrome remains a rare, but potentially life threatening complication of long bone fractures. The true incidence is difficult to assess as many cases remain undiagnosed. Cerebral involvement varies from confusion to encephalopathy with coma and seizures. Clinical symptoms and computed tomography are not always diagnostic, while magnetic resonance imaging is more sensitive in the detection of a suspected brain embolism. Two cases of post-traumatic cerebral fat embolism, manifested by prolonged coma and diffuse cerebral oedema, are presented. The clinical course of the disease as well as the intensive care unit management are discussed.
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Affiliation(s)
- L Gregorakos
- Intensive Care Unit, Athens Trauma Hospital, Greece
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