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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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Spartalis E, Plakopitis N, Theodori MA, Karagiannis SP, Athanasiadis DI, Spartalis M, Boutzios G, Paschou SA, Nikiteas N, Troupis T. Thyroid cancer surgery during the coronavirus disease 2019 pandemic: perioperative management and oncological and anatomical considerations. Future Oncol 2021; 17:4389-4395. [PMID: 34431326 PMCID: PMC8386469 DOI: 10.2217/fon-2021-0585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 12/28/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has changed many aspects of our everyday lives and medical practice, including oncology treatment; thyroid cancer surgery is not an exception. The reported number of fine-needle aspirations performed during the first semester of 2020 was significantly reduced. Poorly differentiated, medullary and anaplastic thyroid tumors are considered important indications for immediate surgical intervention. By contrast, most well-differentiated carcinomas present slow growth, and thus surgery can be deferred for a short period of time during which patients are under active surveillance. Thyroid surgeries have decreased during the COVID-19 pandemic. Furthermore, prior to any intervention, negative COVID-19 status - with the use of a nasopharyngeal swab and reverse transcription PCR assay as the gold standard and chest CT scan as a complementary modality in some cases - must be confirmed to achieve a COVID-free pathway. Thorough preoperative assessment regarding both oncological and anatomical aspects should be performed to identify optimal timing for safe management.
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Affiliation(s)
- Eleftherios Spartalis
- Laboratory of Experimental Surgery & Surgical Research 'N S Christeas', Medical School, National & Kapodistrian University of Athens, Athens, 11527, Greece.,Department of Anatomy, Medical School, National & Kapodistrian University of Athens, Athens, 11527, Greece
| | - Nikolaos Plakopitis
- Laboratory of Experimental Surgery & Surgical Research 'N S Christeas', Medical School, National & Kapodistrian University of Athens, Athens, 11527, Greece
| | - Maria Anna Theodori
- Laboratory of Experimental Surgery & Surgical Research 'N S Christeas', Medical School, National & Kapodistrian University of Athens, Athens, 11527, Greece
| | - Sotirios P Karagiannis
- Laboratory of Experimental Surgery & Surgical Research 'N S Christeas', Medical School, National & Kapodistrian University of Athens, Athens, 11527, Greece
| | | | - Michael Spartalis
- Laboratory of Experimental Surgery & Surgical Research 'N S Christeas', Medical School, National & Kapodistrian University of Athens, Athens, 11527, Greece
| | - Georgios Boutzios
- Department of Pathophysiology, Endocrine Unit, Medical School, National & Kapodistrian University of Athens, Athens, 11527, Greece
| | - Stavroula A Paschou
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National & Kapodistrian University of Athens, Athens, 11528, Greece
| | - Nikolaos Nikiteas
- Second Department of Propaedeutic Surgery, Medical School, National & Kapodistrian University of Athens, Athens, 11527, Greece
| | - Theodore Troupis
- Department of Anatomy, Medical School, National & Kapodistrian University of Athens, Athens, 11527, Greece
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Spartalis E, Karagiannis SP, Plakopitis N, Theodori MA, Athanasiadis DI, Schizas D, Spartalis M, Troupis T. Percutaneous laser ablation of cervical metastatic lymph nodes in papillary thyroid carcinoma: clinical efficacy and anatomical considerations. Expert Rev Med Devices 2020; 18:75-82. [PMID: 33307870 DOI: 10.1080/17434440.2021.1864323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Background: Papillary thyroid carcinoma is the most common type of thyroid cancer; despite its generally indolent course, patients often develop local post-operative recurrences. Re-operation, however, holds a high complication rate, while at the same time, not all patients benefit from radioiodine ablation. This systematic review investigates the application of laser ablation therapy (LAT) for cervical lymph node metastases as an additional treatment modality.Methods: This systematic review was conducted in accordance with the PRISMA Statement. Medline electronic database and Cochrane Library were searched for eligible articles.Results: Five studies were included in the systematic review. All studies included patients with metastatic lymph nodes from papillary thyroid carcinoma, that were unsuitable for further radioiodine or surgical treatment. Patients were treated with two different LAT devices. Regardless of the utilized assessment modalities, all researchers reported significant outcomes on local disease control. No permanent complications were observed.Conclusions: LAT is relatively safe and effective for the treatment of cervical metastatic lymph nodes in patients with papillary thyroid carcinoma.
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Affiliation(s)
- Eleftherios Spartalis
- 2nd Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios P Karagiannis
- 4th Department of Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Plakopitis
- 2nd Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Anna Theodori
- 2nd Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Spartalis
- Laboratory of Experimental Surgery and Surgical Research "N.S Christeas", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodore Troupis
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Spartalis E, Karagiannis SP, Plakopitis N, Theodori MA, Chrysikos D, Paschou SA, Boutzios G, Schizas D, Spartalis M, Troupis T, Nikiteas N. Single-session high-intensity focused ultrasound (HIFU) ablation for benign thyroid nodules: a systematic review. Expert Rev Med Devices 2020; 17:759-771. [PMID: 32749167 DOI: 10.1080/17434440.2020.1806053] [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] [Indexed: 01/20/2023]
Abstract
BACKGROUND Thyroid nodules are common; the majority of them are benign and asymptomatic. Thyroidectomy might be an option; however, the frequency of post-operative complications mandates the development of alternative approaches, such as high-intensity focused ultrasound ablation (HIFU). HIFU induces thermal destruction without penetrating the skin. The present systematic review aims to synthesize all available data, evaluating studies with single-session HIFU therapy and investigating its efficacy. MATERIALS AND METHODS This systematic review was conducted in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and MetaAnalyses). Eligible articles were identified by a search of Medline bibliographic database (PubMed) and Cochrane Library. Out of 39 results, 11 articles were considered to meet the inclusion criteria. RESULTS All eligible studies included patients with solid or predominantly solid benign thyroid nodules. All patients were treated with the same HIFU device. The success rate of the method was defined in the majority, with the volume reduction rate (VRR) over 50% from baseline. The mean or median VRR ranged from 48.7 to 70.41%, depending on the last follow-up date. No major complications were observed. CONCLUSION Single-session HIFU is safe and effective for the treatment of benign thyroid nodules.
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Affiliation(s)
- Eleftherios Spartalis
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Sotirios P Karagiannis
- 4th Department of Surgery, National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Nikolaos Plakopitis
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Maria Anna Theodori
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Dimosthenis Chrysikos
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Stavroula A Paschou
- Division of Endocrinology and Diabetes, Aghia Sophia Hospital, National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Georgios Boutzios
- Endocrine Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens , Athens, Greece
| | - Michael Spartalis
- Laboratory of Experimental Surgery and Surgical Research "N.S Christeas", National and Kapodistrian University of Athens, Medical School , Athens, Greece
| | - Theodore Troupis
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Nikolaos Nikiteas
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School , Athens, Greece
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