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Papiris SA, Veith M, Papaioannou AI, Apollonatou V, Ferrarotti I, Ottaviani S, Tzouvelekis A, Tzilas V, Rovina N, Stratakos G, Gerogianni I, Daniil Z, Kolilekas L, Dimakou K, Pitsidianakis G, Tzanakis N, Tryfon S, Fragopoulos F, Antonogiannaki EM, Lazaratou A, Fouka E, Papakosta D, Emmanouil P, Anagnostopoulos N, Karampitsakos T, Vlami K, Kallieri M, Lyberopoulos P, Loukides S, Bouros D, Bush A, Balduyck M, Lombard C, Cottin V, Mornex JF, Vogelmeier CF, Greulich T, Manali ED. Alpha1-antitrypsin deficiency in Greece: Focus on rare variants. Pulmonology 2024; 30:43-52. [PMID: 36797151 DOI: 10.1016/j.pulmoe.2022.12.007] [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: 08/08/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 02/16/2023] Open
Abstract
PURPOSE A1Antitrypsin deficiency (AATD) pathogenic mutations are expanding beyond the PI*Z and PI*S to a multitude of rare variants. AIM to investigate genotype and clinical profile of Greeks with AATD. METHODS Symptomatic adult-patients with early-emphysema defined by fixed airway obstruction and computerized-tomography scan and lower than normal serum AAT levels were enrolled from reference centers all over Greece. Samples were analyzed in the AAT Laboratory, University of Marburg-Germany. RESULTS Included are 45 adults, 38 homozygous or compound heterozygous for pathogenic variants and 7 heterozygous. Homozygous were 57.9% male, 65.8% ever-smokers, median (IQR) age 49.0(42.5-58.5) years, AAT-levels 0.20(0.08-0.26) g/L, FEV1(%predicted) 41.5(28.8-64.5). PI*Z, PI*Q0, and rare deficient allele's frequency was 51.3%, 32.9%,15.8%, respectively. PI*ZZ genotype was 36.8%, PI*Q0Q0 21.1%, PI*MdeficientMdeficient 7.9%, PI*ZQ0 18.4%, PI*Q0Mdeficient 5.3% and PI*Zrare-deficient 10.5%. Genotyping by Luminex detected: p.(Pro393Leu) associated with MHeerlen (M1Ala/M1Val); p.(Leu65Pro) with MProcida; p.(Lys241Ter) with Q0Bellingham; p.(Leu377Phefs*24) with Q0Mattawa (M1Val) and Q0Ourem (M3); p.(Phe76del) with MMalton (M2), MPalermo (M1Val), MNichinan (V) and Q0LaPalma (S); p.(Asp280Val) with PLowell (M1Val); PDuarte (M4), YBarcelona (p.Pro39His). Gene-sequencing (46.7%) detected Q0GraniteFalls, Q0Saint-Etienne, Q0Amersfoort(M1Ala), MWürzburg, NHartfordcity and one novel-variant (c.1A>G) named Q0Attikon.Heterozygous included PI*MQ0Amersfoort(M1Ala), PI*MMProcida, PI*Mp.(Asp280Val), PI*MOFeyzin. AAT-levels were significantly different between genotypes (p = 0.002). CONCLUSION Genotyping AATD in Greece, a multiplicity of rare variants and a diversity of rare combinations, including unique ones were observed in two thirds of patients, expanding knowledge regarding European geographical trend in rare variants. Gene sequencing was necessary for genetic diagnosis. In the future the detection of rare genotypes may add to personalize preventive and therapeutic measures.
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Affiliation(s)
- S A Papiris
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece.
| | - M Veith
- Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), UKGM, Marburg, Germany
| | - A I Papaioannou
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - V Apollonatou
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - I Ferrarotti
- Center for Diagnosis of Inherited Alpha1-antitrypsin Deficiency, Department of Internal Medicine and Therapeutics, Pneumonology Unit, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - S Ottaviani
- Center for Diagnosis of Inherited Alpha1-antitrypsin Deficiency, Department of Internal Medicine and Therapeutics, Pneumonology Unit, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
| | - A Tzouvelekis
- Department of Respiratory Medicine, General Hospital of Patras, University of Patras, Greece
| | - V Tzilas
- 5th Pulmonary Department, Athens Chest Hospital "Sotiria", Athens Greece
| | - N Rovina
- 1st Department of Pulmonary Medicine and Intensive Care Unit, Medical School, National and Kapodistrian University of Athens, Athens 115 27, Greece
| | - G Stratakos
- 1st Respiratory Medicine Department of the National, Kapodistrian University of Athens, Athens, Greece
| | - I Gerogianni
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa Greece
| | - Z Daniil
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa Greece
| | - L Kolilekas
- 7thPulmonary Department, Athens Chest Hospital "Sotiria", Athens Greece
| | - K Dimakou
- 5th Pulmonary Department, Athens Chest Hospital "Sotiria", Athens Greece
| | - G Pitsidianakis
- Department of Thoracic Medicine, University Hospital, University of Crete, Heraklion, Crete 71110, Greece
| | - N Tzanakis
- Department of Thoracic Medicine, University Hospital, University of Crete, Heraklion, Crete 71110, Greece
| | - S Tryfon
- General Hospital "G. Papanikolaou", Thessaloniki, Greece
| | - F Fragopoulos
- Pulmonary Department, General Hospital of Nicosia, Cyprus
| | - E M Antonogiannaki
- 4th Pulmonary Department, Athens Chest Hospital "Sotiria", Athens Greece
| | - A Lazaratou
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - E Fouka
- A Department of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Exochi, Thessaloniki, Greece
| | - D Papakosta
- A Department of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Exochi, Thessaloniki, Greece
| | | | - N Anagnostopoulos
- 1st Respiratory Medicine Department of the National, Kapodistrian University of Athens, Athens, Greece
| | - T Karampitsakos
- Department of Respiratory Medicine, General Hospital of Patras, University of Patras, Greece
| | - K Vlami
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - M Kallieri
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - P Lyberopoulos
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - S Loukides
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
| | - D Bouros
- Iatriko Medical Center, Athens, Greece; School of Medicine, National and Kapodistrian University of Athens, Athens Greece
| | - A Bush
- Paediatrics and Paediatric Respirology, Imperial College, Imperial Centre for Paediatrics and Child Health, Royal Brompton Harefield NHS Foundation Trust, London, United Kingdom
| | - M Balduyck
- laboratoire de Biochimie et Biologie Moléculaire (HMNO), Centre de Biologie Pathologie, Faculté de pharmacie et EA 7364 RADEME, Laboratoire de Biochimie et Biologie Moléculaire, CHU de Lille, Université de Lille, Lille, France
| | - C Lombard
- Laboratoire d'Immunologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon and Université Claude Bernard-Lyon 1, Lyon, France
| | - V Cottin
- Service de pneumologie, Centre National Coordinateur de Référence des Maladies Pulmonaires Rares, Hôpital Louis Pradel, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, UMR754 INRA, IVPC, Lyon, France
| | - J F Mornex
- Service de pneumologie, Centre National Coordinateur de Référence des Maladies Pulmonaires Rares, Hôpital Louis Pradel, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, UMR754 INRA, IVPC, Lyon, France
| | - C F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), UKGM, Marburg, Germany
| | - T Greulich
- Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), UKGM, Marburg, Germany
| | - E D Manali
- 2nd Pulmonary Medicine Department, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Greece 1 Rimini Street, Haidari 12462, Greece
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Paraskevis D, Gkova M, Mellou K, Gerolymatos G, Psalida N, Gkolfinopoulou K, Kostaki EG, Loukides S, Kotanidou A, Skoutelis A, Thiraios E, Saroglou G, Zografopoulos D, Filippou D, Mossialos E, Zaoutis T, Gaga M, Tsiodras S, Antoniadou A. Real-world Effectiveness of Molnupiravir and Nirmatrelvir/Ritonavir as Treatments for COVID-19 in Patients at High Risk. J Infect Dis 2023; 228:1667-1674. [PMID: 37565522 PMCID: PMC10733724 DOI: 10.1093/infdis/jiad324] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/16/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Using a retrospective cohort study design, we aimed to evaluate the effectiveness of molnupiravir and nirmatrelvir/ritonavir in patients with SARS-CoV-2 who were highly vulnerable. METHODS The impact of each drug was determined via comparisons with age-matched control groups of patients positive for SARS-CoV-2 who did not receive oral antiviral therapy. RESULTS Administration of molnupiravir significantly reduced the risk of hospitalization (odds ratio [OR], 0.40; P < .001) and death (OR, 0.31; P < .001) among these patients based on data adjusted for age, previous SARS-CoV-2 infection, vaccination status, and time elapsed since the most recent vaccination. The reductions in risk were most profound among elderly patients (≥75 years old) and among those with high levels of drug adherence. Administration of nirmatrelvir/ritonavir also resulted in significant reductions in the risk of hospitalization (OR, 0.31; P < .001) and death (OR, 0.28; P < .001). Similar to molnupiravir, the impact of nirmatrelvir/ritonavir was more substantial among elderly patients and in those with high levels of drug adherence. CONCLUSIONS Collectively, these real-world findings suggest that although the risks of hospitalization and death due to COVID-19 have been reduced, antivirals can provide additional benefits to members of highly vulnerable patient populations.
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Affiliation(s)
- Dimitrios Paraskevis
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens
- National Public Health Organization
| | | | | | | | | | | | - Evangelia-Georgia Kostaki
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens
| | - Stylianos Loukides
- Second Respiratory Medicine Department, “Attikon” University Hospital, Medical School, National and Kapodistrian University of Athens
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine and Pulmonary Services, Evaggelismos Hospital, Medical School, National and Kapodistrian University of Athens
| | | | | | | | | | - Dimitrios Filippou
- Department of Anatomy and Surgical Anatomy, Medical School, National and Kapodistrian University of Athens
- National Organization for Medicines, Athens, Greece
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science
- Institute of Global Health Innovation, Imperial College London, United Kingdom
| | - Theoklis Zaoutis
- National Public Health Organization
- Infectious Diseases Unit, Second Department of Pediatrics, “P. and A. Kyriakou” Children's Hospital, National and Kapodistrian University of Athens
| | - Mina Gaga
- Seventh Respiratory Medicine Department, General Hospital for Chest Diseases of Athens “SOTIRIA,”
| | - Sotirios Tsiodras
- National Public Health Organization
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Anastasia Antoniadou
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
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Farr A, Cuevas Ocaña S, Gille T, Pinnock H, Bonsignore MR, Roche N, Laveneziana P, Costello RW, Harari S, Meiners S, Loukides S, Cruz J. What to expect from the ERS International Congress 2023. Breathe (Sheff) 2023; 19:230107. [PMID: 37492348 PMCID: PMC10365073 DOI: 10.1183/20734735.0107-2023] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023] Open
Abstract
This article provides an overview of the reasons to attend the 2023 ERS Congress, including a summary of the ECM session and the NEXT programme. https://bit.ly/46ghP4g.
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Affiliation(s)
- Amy Farr
- Education Department, European Respiratory Society, Lausanne, Switzerland
| | - Sara Cuevas Ocaña
- Nottingham Biodiscovery Institute, University of Nottingham, Nottingham, UK
| | - Thomas Gille
- Hôpitaux de Paris, Hôpitaux Universitaires de Paris Seine-Saint-Denis, Service de Physiologie et Explorations Fonctionnelles, Bobigny, France
- Université Sorbonne Paris Nord, UFR de Santé Médecine Biologie Humaine, Inserm U1272 “Hypoxia and the Lung”, Bobigny, France
| | - Hilary Pinnock
- The University of Edinburgh, Allergy and Respiratory Research Group, Usher Institute, Edinburgh, UK
| | - Maria R. Bonsignore
- University of Palermo, PROMISE Department, Palermo, Italy
- Cervello Hospital, Division of Respiratory Medicine, Palermo, Italy
- Institute of Translational Pharmacology (IFT), Palermo branch, National Research Council (CNR), Palermo, Italy
| | - Nicolas Roche
- Respiratory Medicine, Cochin Hospital, APHP Centre, Université Paris Cité, Cochin Institute (UMR1016), Paris, France
| | - Pierantonio Laveneziana
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, sites Pitié-Salpêtrière, Saint-Antoine et Tenon, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), Paris, France
| | - Richard W. Costello
- RCSI Education and Research Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Sergio Harari
- MultiMedica IRCCS, Division of Pneumology, Semi-Intensive Care Unit, Milan, Italy
- Università di Milano, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Silke Meiners
- Research Center Borstel/Leibniz Lung Center, Borstel, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Borstel, Germany
- Institute of Experimental Medicine, Christian-Albrechts University Kiel, Kiel, Germany
| | - Stylianos Loukides
- National and Kapodistrian University of Athens, Medical School, Athens, Greece
- Attiko University Hospital, Respiratory Medicine Department, Athens, Greece
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences (ESSLei), Polytechnic of Leiria, Leiria, Portugal
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Manali ED, Kannengiesser C, Borie R, Ba I, Bouros D, Markopoulou A, Antoniou K, Kolilekas L, Papaioannou AI, Tzilas V, Tzouvelekis A, Daniil Z, Fouka E, Papakosta D, Xyfteri A, Karakatsani A, Loukides S, Korbila I, Tomos IP, Konstantinidis AK, Gogali A, Steiropoulos P, Papanikolaou IC, Bazaka C, Haritou A, Vassilakopoulos T, Maniati M, Kagouridis K, Markozannes E, Bouros E, Rampiadou C, Kounti G, Trachalaki A, Dimeas I, Karampitsakos T, Lyberopoulos P, Malamadakis N, Spyropoulou S, Revy P, Lainey E, Dieudé P, Rebah K, Ménard C, Oudin C, Masson C, Plessier A, Legendre M, Nathan N, Coulomb-L'Hermine A, Clement A, Amselem S, Boileau C, Crestani B, Papiris S. Genotype-Phenotype Relationships in Inheritable Idiopathic Pulmonary Fibrosis: A Greek National Cohort Study. Respiration 2022; 101:531-543. [PMID: 35078193 DOI: 10.1159/000520657] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Monogenic and polygenic inheritances are evidenced for idiopathic pulmonary fibrosis (IPF). Pathogenic variations in surfactant protein-related genes, telomere-related genes (TRGs), and a single-nucleotide polymorphism in the promoter of MUC5B gene encoding mucin 5B (rs35705950 T risk allele) are reported. This French-Greek collaborative study, Gen-Phen-Re-GreekS in inheritable IPF (iIPF), aimed to investigate genetic components and patients' characteristics in the Greek national IPF cohort with suspected heritability. PATIENTS AND METHODS 150 patients with familial PF, personal-family extrapulmonary disease suggesting short telomere syndrome, and/or young age IPF were analyzed. RESULTS MUC5B rs35705950 T risk allele was detected in 103 patients (90 heterozygous, 13 homozygous, allelic frequency of 39%), monoallelic TRG pathogenic variations in 19 patients (8 TERT, 5 TERC, 2 RTEL1, 2 PARN, 1 NOP10, and 1 NHP2), and biallelic ABCA3 pathogenic variations in 3. Overlapping MUC5B rs35705950 T risk allele and TRG pathogenic variations were shown in 11 patients (5 TERT, 3 TERC, 1 PARN, 1 NOP10, and 1 NHP2), MUC5B rs35705950 T risk allele, and biallelic ABCA3 pathogenic variations in 2. In 38 patients, neither MUC5B rs35705950 T risk allele nor TRG pathogenic variations were detectable. Kaplan-Meier curves showed differences in time-to-death (p = 0.025) where patients with MUC5B rs35705950 T risk allele alone or in combination with TRG pathogenic variations presented better prognosis. CONCLUSION The Gen-Phen-Re-GreekS in iIPF identified multiple and overlapping genetic components including the rarest, underlying disease's genetic "richesse," complexity and heterogeneity. Time-to-death differences may relate to diverse IPF pathogenetic mechanisms implicating "personalized" medical care driven by genotypes in the near future.
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Affiliation(s)
- Effrosyni D Manali
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Caroline Kannengiesser
- Département de Génétique, APHP Hôpital Bichat, Paris, France.,Université de Paris, Paris, France.,INSERM UMR 1152, Université de Paris, Paris, France
| | - Raphael Borie
- INSERM UMR 1152, Université de Paris, Paris, France.,APHP, Service de Pneumologie A, Centre de Référence des Maladies Pulmonaires Rares, FHU APOLLO, Hôpital Bichat, Paris, France
| | - Ibrahima Ba
- Département de Génétique, APHP Hôpital Bichat, Paris, France.,Université de Paris, Paris, France.,INSERM UMR 1152, Université de Paris, Paris, France
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Iatriko Medical Center, Athens, Greece
| | | | - Katerina Antoniou
- Laboratory of Molecular & Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | | | - Andriana I Papaioannou
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Tzilas
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Iatriko Medical Center, Athens, Greece
| | - Argyrios Tzouvelekis
- Department of Respiratory Medicine, General Hospital of Patras, University of Patras, Patras, Greece
| | - Zoe Daniil
- Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Evangelia Fouka
- A Department of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - Despoina Papakosta
- A Department of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | | | - Anna Karakatsani
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Loukides
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Korbila
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis P Tomos
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Athina Gogali
- Department of Pneumonology, Medical School, University of Ioannina, Ioannina, Greece
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, University General Hospital Alexandroupolis, Medical School, Democritus University of Thrace, Thrace, Greece
| | | | | | | | - Theodoros Vassilakopoulos
- 3rd Department of Critical Care Medicine, Evgenideio Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Maniati
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Kagouridis
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Markozannes
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Bouros
- First Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Rampiadou
- Pulmonary Department, "G Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Georgia Kounti
- Pulmonary Department, "G Papanikolaou" General Hospital, Thessaloniki, Greece
| | - Athina Trachalaki
- Laboratory of Molecular & Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Ilias Dimeas
- Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Theodoros Karampitsakos
- Department of Respiratory Medicine, General Hospital of Patras, University of Patras, Patras, Greece
| | - Panagiotis Lyberopoulos
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Malamadakis
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Patrick Revy
- Laboratory of Genome Dynamics in the Immune System, Imagine Institute, INSERM UMR 1163, Labellisé Ligue Contre Le Cancer, Université de Paris, Paris, France
| | - Elodie Lainey
- Service d'Hématologie Biologique, Hôpital Robert Debré, APHP, UMRS 1131, Institut Universitaire d'Hématologie, Paris, France
| | - Philippe Dieudé
- Department of Rheumatology, Hôpital Bichat-Claude Bernard, APHP, INSERM U1152, Université de Paris, Paris, France
| | - Khedidja Rebah
- Département de Génétique, APHP Hôpital Bichat, Paris, France.,Université de Paris, Paris, France
| | - Christelle Ménard
- Département de Génétique, APHP Hôpital Bichat, Paris, France.,Université de Paris, Paris, France
| | - Claire Oudin
- Département de Génétique, APHP Hôpital Bichat, Paris, France.,Université de Paris, Paris, France
| | - Cécile Masson
- Imagine Institute, Bioinformatics Platform, INSERM UMR 1163, Université de Paris, Paris, France
| | | | - Marie Legendre
- Sorbonne Université, INSERM UMR S933 Maladies Génétiques d'Expression Pédiatrique, and Assistance Publique Hôpitaux de Paris, U.F. de Génétique Moléculaire, Hôpital Armand Trousseau, Paris, France
| | - Nadia Nathan
- Sorbonne Université, INSERM UMR S933, France, Assistance Publique Hôpitaux de Paris, Service de Pneumologie Pédiatrique, Hôpital Armand Trousseau, Centre National de Référence des Maladies Respiratoires Rares RespiRare, Paris, France
| | - Aurore Coulomb-L'Hermine
- Service d'Anatomie et de Cytologie Pathologiques, Sorbonne Université, Hôpital d'Enfants Armand Trousseau, Paris, France
| | - Annick Clement
- Sorbonne Université, INSERM UMR S933, France, Assistance Publique Hôpitaux de Paris, Service de Pneumologie Pédiatrique, Hôpital Armand Trousseau, Centre National de Référence des Maladies Respiratoires Rares RespiRare, Paris, France
| | - Serge Amselem
- Sorbonne Université, INSERM UMR S933 Maladies Génétiques d'Expression Pédiatrique, and Assistance Publique Hôpitaux de Paris, U.F. de Génétique Moléculaire, Hôpital Armand Trousseau, Paris, France
| | - Catherine Boileau
- Département de Génétique, APHP Hôpital Bichat, Paris, France.,Université de Paris, Paris, France
| | - Bruno Crestani
- INSERM UMR 1152, Université de Paris, Paris, France.,APHP, Service de Pneumologie A, Centre de Référence des Maladies Pulmonaires Rares, FHU APOLLO, Hôpital Bichat, Paris, France
| | - Spyros Papiris
- 2nd Pulmonary Medicine Department, General University Hospital "Attikon," Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Bakakos P, Papakosta D, Loukides S. Budesonide/formoterol via the Elpenhaler® device in asthmatic patients: A real-world effectiveness study
(The BOREAS Study). Pneumon 2021. [DOI: 10.18332/pne/144485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tzouvelekis A, Akinosoglou K, Karampitsakos T, Panou V, Tomos I, Tsoukalas G, Stratiki M, Dimakou K, Chrysikos S, Papaioannou O, Hillas G, Bakakos P, Stratakos G, Anagnostopoulos A, Koromilias A, Boutou A, Kioumis I, Chloros D, Kontakiotis T, Papakosta D, Papiris S, Manali E, Antonogiannaki EM, Koulouris N, Bouros D, Loukides S, Gogos C. Epidemiological characteristics and outcomes from 187 patients with COVID-19 admitted to 6 reference centers in Greece: an observational study during the first wave of the COVID-19 pandemic. Adv Respir Med 2021; 89:378-385. [PMID: 34494241 DOI: 10.5603/arm.a2021.0087] [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: 02/24/2021] [Accepted: 06/03/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Epidemiological data from patients with COVID-19 has been recently published in several countries. Nationwide data of hospitalized patients with COVID-19 in Greece remain scarce. MATERIAL AND METHODS This was an observational, retrospective study from 6 reference centers between February 26 and May 15, 2020. RESULTS The patients were mostly males (65.7%) and never smokers (57.2%) of median age 60 (95% CI: 57.6-64) years. The majority of the subjects (98%) were treated with the standard-of-care therapeutic regimen at that time, including hydroxychlo-roquine and azithromycin. Median time of hospitalization was 10 days (95% CI: 10-12). Twenty-five (13.3%) individuals were intubated and 8 died (4.2%). The patients with high neutrophil-to-lymphocyte ratio (NLR) ( > 3.58) exhibited more severe disease as indicated by significantly increased World Health Organization (WHO) R&D ordinal scale (4; 95% CI: 4-4 vs 3; 95% CI: 3-4, p = 0.0001) and MaxFiO2% (50; 95% CI: 38.2-50 vs 29.5; 95% CI: 21-31, p < 0.0001). The patients with increased lactate dehydrogenase (LDH) levels ( > 270 IU/ml) also exhibited more advanced disease compared to the low LDH group ( < 270 IU/ml) as indicated by both WHO R&D ordinal scale (4; 95% CI: 4-4 vs 4; 95% CI: 3-4, p = 0.0001) and MaxFiO2% (50; 95% CI: 35-60 vs 28; 95% CI: 21-31, p < 0.0001). CONCLUSION We present the first epidemiological report from a low-incidence and mortality COVID-19 country. NLR and LDH may represent reliable disease prognosticators leading to timely treatment decisions.
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Affiliation(s)
- Argyris Tzouvelekis
- Department of Respiratory Medicine, University Hospital of Patras, University of Patras, Patras, Greece, Greece.,Department of Internal Medicine, University Hospital of Patras, University of Patras, Patras, Greece
| | - Karolina Akinosoglou
- Department of Internal Medicine, University Hospital of Patras, University of Patras, Patras, Greece
| | - Theodoros Karampitsakos
- Department of Respiratory Medicine, University Hospital of Patras, University of Patras, Patras, Greece, Greece. .,Department of Internal Medicine, University Hospital of Patras, University of Patras, Patras, Greece.
| | - Vassiliki Panou
- 1st Academic Department of Respiratory Medicine, SOTIRIA General Hospital for Thoracic Diseases, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Tomos
- 2nd Academic Department of Respiratory Medicine, ATTIKON General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsoukalas
- 4th Department of Respiratory Medicine, SOTIRIA General Hospital, Athens, Greece
| | - Magdalini Stratiki
- 4th Department of Respiratory Medicine, SOTIRIA General Hospital, Athens, Greece
| | - Katerina Dimakou
- 5th Department of Respiratory Medicine, SOTIRIA General Hospital, Athens, Greece
| | - Serafeim Chrysikos
- 5th Department of Respiratory Medicine, SOTIRIA General Hospital, Athens, Greece
| | - Ourania Papaioannou
- Department of Respiratory Medicine, University Hospital of Patras, University of Patras, Patras, Greece, Greece.,5th Department of Respiratory Medicine, SOTIRIA General Hospital, Athens, Greece
| | - Georgios Hillas
- 5th Department of Respiratory Medicine, SOTIRIA General Hospital, Athens, Greece
| | - Petros Bakakos
- 1st Academic Department of Respiratory Medicine, SOTIRIA General Hospital for Thoracic Diseases, National and Kapodistrian University of Athens, Athens, Greece
| | - Grigoris Stratakos
- 1st Academic Department of Respiratory Medicine, SOTIRIA General Hospital for Thoracic Diseases, National and Kapodistrian University of Athens, Athens, Greece
| | - Aris Anagnostopoulos
- 1st Academic Department of Respiratory Medicine, SOTIRIA General Hospital for Thoracic Diseases, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Koromilias
- 1st Academic Department of Respiratory Medicine, SOTIRIA General Hospital for Thoracic Diseases, National and Kapodistrian University of Athens, Athens, Greece
| | - Afroditi Boutou
- Department of Respiratory Medicine, Papanikolaou General Hospital, Thessaloniki, Greece
| | - Ioannis Kioumis
- Department of Respiratory Failure, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Diamantis Chloros
- Department of Respiratory Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Kontakiotis
- Department of Respiratory Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despoina Papakosta
- Department of Respiratory Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyridon Papiris
- 2nd Academic Department of Respiratory Medicine, ATTIKON General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Effrosyni Manali
- 2nd Academic Department of Respiratory Medicine, ATTIKON General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elvira-Markela Antonogiannaki
- 2nd Academic Department of Respiratory Medicine, ATTIKON General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Koulouris
- 1st Academic Department of Respiratory Medicine, SOTIRIA General Hospital for Thoracic Diseases, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- 1st Academic Department of Respiratory Medicine, SOTIRIA General Hospital for Thoracic Diseases, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Loukides
- 2nd Academic Department of Respiratory Medicine, ATTIKON General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalampos Gogos
- Department of Internal Medicine, University Hospital of Patras, University of Patras, Patras, Greece
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7
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Papiris SA, Bouros D, Markopoulou K, Kolilekas L, Papaioannou AI, Tzilas V, Tzouvelekis A, Fouka E, Papakosta D, Daniil Z, Steiropoulos P, Gogali A, Papanikolaou IC, Xyfteri A, Haritou A, Korbila I, Tomos IP, Loukides S, Bellelli R, Kounti G, Rampiadou C, Karampitsakos T, Dimeas I, Kirgou P, Bompoki A, Vasarmidi E, Loverdos K, Antonogiannaki EM, Blizou M, Bouros E, Kagouridis K, Maniati M, Karakatsani A, Antoniou KM, Manali ED. Early COVID-19 lockdown in Greece and idiopathic pulmonary fibrosis: a beneficial "impact" beyond any expectation. Eur Respir J 2021; 57:13993003.03111-2020. [PMID: 33334934 DOI: 10.1183/13993003.03111-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/08/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Spyros A Papiris
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- First Academic Dept of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Iatriko Medical Center, Athens, Greece
| | | | | | - Andriana I Papaioannou
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Argyrios Tzouvelekis
- Dept of Respiratory Medicine, General Hospital of Patras, University of Patras, Patra, Greece
| | - Eva Fouka
- A Dept of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - Despoina Papakosta
- A Dept of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - Zoe Daniil
- Dept of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Paschalis Steiropoulos
- Dept of Pneumonology, University Hospital of Alexandroupolis, Democritus University of Thrace, Komotini, Greece
| | - Athina Gogali
- Dept of Pneumonology, Medical School, University of Ioannina, Ioannina, Greece
| | | | | | | | - Ioanna Korbila
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis P Tomos
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Loukides
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rita Bellelli
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Kounti
- Pulmonary Dept, "G Papanikolaou" General Hospital, Thessaloniki, Greece
| | | | - Theodoros Karampitsakos
- Dept of Respiratory Medicine, General Hospital of Patras, University of Patras, Patra, Greece
| | - Ilias Dimeas
- Dept of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Paraskevi Kirgou
- Dept of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Andromachi Bompoki
- Dept of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Eirini Vasarmidi
- Dept of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | | | - Elvira-Markela Antonogiannaki
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Myrto Blizou
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Konstantinos Kagouridis
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Maniati
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Karakatsani
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina M Antoniou
- Dept of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece.,These authors contributed equally to this work
| | - Effrosyni D Manali
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,These authors contributed equally to this work
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8
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Stefanidis K, Konstantelou E, Yusuf GT, Oikonomou A, Tavernaraki K, Karakitsos D, Loukides S, Vlahos I. Radiological, epidemiological and clinical patterns of pulmonary viral infections. Eur J Radiol 2021; 136:109548. [PMID: 33485125 PMCID: PMC7808729 DOI: 10.1016/j.ejrad.2021.109548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 01/07/2023]
Abstract
Respiratory viruses are the most common causes of acute respiratory infections. However, identification of the underlying viral pathogen may not always be easy. Clinical presentations of respiratory viral infections usually overlap and may mimic those of diseases caused by bacteria. However, certain imaging morphologic patterns may suggest a particular viral pathogen as the cause of the infection. Although definitive diagnosis cannot be made on the basis of clinical or imaging features alone, the use of a combination of clinical and radiographic findings can substantially improve the accuracy of diagnosis. The purpose of this review is to present the clinical, epidemiological and radiological patterns of lower respiratory tract viral pathogens providing a comprehensive approach for their diagnosis and identification in hospitals and community outbreaks.
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Affiliation(s)
| | - Elissavet Konstantelou
- 1st Respiratory Department of the National and Kapodistrian University of Athens, “Sotiria” General and Chest Diseases’ Hospital, Athens, Greece
| | | | - Anastasia Oikonomou
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Kyriaki Tavernaraki
- Imaging and Interventional Radiology, Sotiria General and Chest Diseases Hospital, Athens, Greece
| | | | - Stylianos Loukides
- 2nd Respiratory Department of the National and Kapodistrian University of Athens, “Attikon” General Hospital, Athens, Greece
| | - Ioannis Vlahos
- Department of Thoracic Radiology, Division of Diagnostic Imaging. University of Texas MD Anderson Cancer Center, Houston, TX, USA
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9
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Bakakos A, Loukides S, Usmani OS, Bakakos P. Biologics in severe asthma: the overlap endotype - opportunities and challenges. Expert Opin Biol Ther 2020; 20:1427-1434. [PMID: 32779950 DOI: 10.1080/14712598.2020.1809651] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Patients with severe asthma experience a significant burden of symptoms, disease exacerbations and medication side-effects. Severe asthma interferes with the patients' quality of life and has high health-care costs. New targeted biologic therapies have improved the management of severe asthma by significantly reducing exacerbations and maintenance corticosteroid use, and also improving lung function and patient quality of life. AREAS COVERED Not all severe asthmatics are eligible for such therapies. Those with allergic and eosinophilic asthma, usually referred to as 'T2-high' asthma benefit from anti-IgE and anti-IL-5/5 R antibodies respectively, whereas some asthmatics are eligible for both: 'overlap' endotype. In this review, we present briefly the monoclonal antibodies that have been approved in the management of severe asthma and we focus on the 'overlap' endotype. EXPERT OPINION Since these therapies are costly, it is extremely important to choose the right treatment for the right patient especially in the 'overlapping' one. The decision is mainly based on the judgment of the clinician and is often driven by the most easily obtainable biomarker, thus the blood eosinophil count. Comorbidities, patient's input and administration frequency may aid the decision of choosing one over another biologic.
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Affiliation(s)
- A Bakakos
- 1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens , Athens Greece
| | - S Loukides
- 2 University Department of Respiratory Medicine, National and Kapodistrian University of Athens , Athens Greece
| | - O S Usmani
- Airways Disease Section, National Heart and Lung Institute, Imperial College London, & Royal Brompton Hospital , UK
| | - P Bakakos
- 1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens , Athens Greece
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10
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Abstract
Asthma is a heterogeneous disease with diverse severity and represents a considerable socio-economic burden. Exhaled Breath Condensate (EBC) is a biofluid directly obtained from the airway lining fluid non-invasively. We attempted to discriminate severe from mild-to-moderate asthma using EBC metabolomics based on both NMR and UHPLC-MS techniques. 36 patients were included in this study (15 patients with severe and 21 with mild-to-moderate asthma). EBC was collected and analyzed using both NMR and UHPLC-MS techniques for possible metabolites. Using PLS and oPLS analysis for the UHPLC-MS data, no metabolite was found to be sufficient for the discrimination of asthma severity. However, when another PLS-regression model was applied five metabolites were found to discriminate severe from mild-to-moderate asthma. Amino-acid lysine was the only metabolite that discriminated the two study groups using NMR data (p= 0.04, t-test with Welch's correction, AUC 0.66). EBC is an easily available biofluid which directly represents the lower airways but difficult-to-use for metabolomic analysis. Our study presents some encouraging findings for the discrimination of asthma severity subgroups using EBC metabolomics but more well-designed studies with a higher number of patients need to be conducted.
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Affiliation(s)
- P Ntontsi
- 2nd Respiratory Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
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11
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Loukides S, Kovacs G, Bentata K, Huyền T, Shah BK, Mazulov O, Eber E. Summer schools of adult and paediatric respiratory medicine: course report. Breathe (Sheff) 2020; 16:190305. [PMID: 32494301 PMCID: PMC7249785 DOI: 10.1183/20734735.0305-2019] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The European Respiratory Society (ERS) has a long tradition of organising major congresses and courses in various areas of respiratory medicine in order to share knowledge and promote clinical education. The courses are led by respiratory specialists committed to the ERS and having great experience in the field. One of the most important courses is the ERS Summer School of Adult Respiratory Medicine. This particular course aims to provide a detailed overview of up-to-date, established clinical knowledge, mainly for early career respiratory physicians. It discusses the most important questions of respiratory medicine, including obstructive airway diseases, respiratory infections, tuberculosis, cystic fibrosis, bronchiectasis, lung cancer, mesothelioma, pleural diseases, sleep disorders, vascular diseases, interstitial lung diseases, sarcoidosis, lung function tests and imaging. The course represents an ideal tool for the preparation for the HERMES diploma. The @EuroRespSoc summers schools of adult and paediatric respiratory medicine took place on June 12–15, 2019, in Barcelona, Spainhttp://bit.ly/38VPAc5
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Affiliation(s)
- Stylianos Loukides
- National and Kapodistrian University of Athens, Medical School, 2nd Respiratory Medicine Dept, Athens, Greece
| | - Gabor Kovacs
- Medical University of Graz and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Kada Bentata
- Medical Faculty and Hospital of Mostaganem, Mostaganem, Algeria
| | - Thanh Huyền
- University of Medicine and Pharmacy of Ho Chi Minh City, Pulmonary Department, Chợ Rẫy Hospital, Ho Chi Minh City, Vietnam
| | | | - Oleksandr Mazulov
- National Pirogov Medical University, Vinnytsya Children's Regional Hospital, Pulmonology Dept, Vinnytsya, Ukraine
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Dept of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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12
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Affiliation(s)
- Stylianos Loukides
- 1 Attiko University Hospital National and Kapodistrian University of Athens Medical School Athens, Greece and
| | - Petros Bakakos
- 2 Sotiria Chest Diseases Hospital National and Kapodistrian University of Athens Medical School Athens, Greece
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13
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Boura P, Grapsa D, Loukides S, Angelidou M, Tsakanika K, Syrigos N, Gkiozos I. The prognostic value of serum and bronchoalveolar lavage levels of adiponectin in advanced non-small-cell lung cancer. Lung Cancer Manag 2017; 6:55-65. [PMID: 30643571 DOI: 10.2217/lmt-2016-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 07/10/2017] [Indexed: 01/09/2023] Open
Abstract
Aim We aimed to explore the prognostic implications of adiponectin (APN) levels in the serum and bronchoalveolar lavage (BAL) of patients with advanced NSCLC. Materials & methods 29 newly diagnosed patients with stage IV NSCLC were prospectively enrolled. Baseline serum and BAL levels of APN were assayed by ELISA and correlated with various clinicopathological parameters, including overall survival. Results No statistically significant correlations were observed between the serum or BAL levels of APN and the clinicopathological parameters evaluated. The only prognostic factor identified, both by univariate and multivariate survival analyses, was performance status. Conclusion The results of our cohort failed to reveal any prognostic significance of serum and BAL levels of APN in stage IV NSCLC.
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Affiliation(s)
- Paraskevi Boura
- Oncology Unit GPP, 'Sotiria' General Hospital, Medical School, University of Athens, 11527, Athens, Greece.,Oncology Unit GPP, 'Sotiria' General Hospital, Medical School, University of Athens, 11527, Athens, Greece
| | - Dimitra Grapsa
- Oncology Unit GPP, 'Sotiria' General Hospital, Medical School, University of Athens, 11527, Athens, Greece.,Oncology Unit GPP, 'Sotiria' General Hospital, Medical School, University of Athens, 11527, Athens, Greece
| | - Stylianos Loukides
- Oncology Unit GPP, 'Sotiria' General Hospital, Medical School, University of Athens, 11527, Athens, Greece.,Oncology Unit GPP, 'Sotiria' General Hospital, Medical School, University of Athens, 11527, Athens, Greece
| | - Maria Angelidou
- 3rd Pulmonary Department, Sismanoglio General Hospital, 15126, Athens, Greece.,3rd Pulmonary Department, Sismanoglio General Hospital, 15126, Athens, Greece
| | - Konstantina Tsakanika
- Flow Cytometry Unit, Sismanoglio General Hospital,15126, Athens, Greece.,Flow Cytometry Unit, Sismanoglio General Hospital,15126, Athens, Greece
| | - Nikolaos Syrigos
- Oncology Unit GPP, 'Sotiria' General Hospital, Medical School, University of Athens, 11527, Athens, Greece.,Oncology Unit GPP, 'Sotiria' General Hospital, Medical School, University of Athens, 11527, Athens, Greece
| | - Ioannis Gkiozos
- Oncology Unit GPP, 'Sotiria' General Hospital, Medical School, University of Athens, 11527, Athens, Greece.,Oncology Unit GPP, 'Sotiria' General Hospital, Medical School, University of Athens, 11527, Athens, Greece
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14
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Ntontsi P, Loukides S, Bakakos P, Kostikas K, Papatheodorou G, Papathanassiou E, Hillas G, Koulouris N, Papiris S, Papaioannou AI. Clinical, functional and inflammatory characteristics in patients with paucigranulocytic stable asthma: Comparison with different sputum phenotypes. Allergy 2017; 72:1761-1767. [PMID: 28407269 DOI: 10.1111/all.13184] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND According to induced sputum cell count, four different asthma phenotypes have been recognized (eosinophilic, neutrophilic, mixed and paucigranulocytic). The aim of this study was to detect functional and inflammatory characteristics of patients with paucigranulocytic asthma. METHODS A total of 240 asthmatic patients were categorized into the four phenotypes according to cell counts in induced sputum. All patients underwent pulmonary function tests, and measurement of fraction of exhaled nitric oxide (FeNO). The levels of IL-8, IL-13 and eosinophilic cationic protein (ECP) were also measured in sputum supernatant. Treatment, asthma control and the presence of severe refractory asthma (SRA) were also recorded. RESULTS Patients were categorized into the four phenotypes as follows: eosinophilic (40%), mixed (6.7%), neutrophilic (5.4%) and paucigranulocytic (47.9%). Although asthma control test did not differ between groups (P=.288), patients with paucigranulocytic asthma had better lung function (FEV1 % pred) [median (IQR): 71.5 (59.0-88.75) vs 69.0 (59.0-77.6) vs 68.0 (60.0-85.5) vs 80.5 (69.7-95.0), P=.009] for eosinophilic, mixed, neutrophilic and paucigranulocytic asthma, respectively, P=.009). SRA occurred more frequently in the eosinophilic and mixed phenotype (41.6% and 43.7%, respectively) and less frequently in the neutrophilic and paucigranulocytic phenotype (25% and 21.7%, respectively, P=.01). FeNO, ECP and IL-8 were all low in the paucigranulocytic, whereas as expected FeNO and ECP were higher in eosinophilic and mixed asthma, while IL-8 was higher in patients with neutrophilic and mixed asthma (P<.001 for all comparisons). Interestingly, 14.8% of patients with paucigranulocytic asthma had poor asthma control. CONCLUSION Paucigranulocytic asthma most likely represents a "benign" asthma phenotype, related to a good response to treatment, rather than a "true" phenotype of asthma. However, paucigranulocytic patients that remain not well controlled despite optimal treatment represent an asthmatic population that requires further study for potential novel targeted interventions.
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Affiliation(s)
- P. Ntontsi
- 2nd Respiratory Medicine Department Attikon Hospital University of Athens Athens Greece
| | - S. Loukides
- 2nd Respiratory Medicine Department Attikon Hospital University of Athens Athens Greece
| | - P. Bakakos
- 1st Respiratory Medicine Department Sotiria Hospital University of Athens Athens Greece
| | - K. Kostikas
- 2nd Respiratory Medicine Department Attikon Hospital University of Athens Athens Greece
| | - G. Papatheodorou
- Clinical Research Unit Athens Army General Hospital Athens Greece
| | - E. Papathanassiou
- 2nd Respiratory Medicine Department Attikon Hospital University of Athens Athens Greece
| | - G. Hillas
- Respiratory Medicine Department Evangelismos Hospital Athens Greece
| | - N. Koulouris
- 1st Respiratory Medicine Department Sotiria Hospital University of Athens Athens Greece
| | - S. Papiris
- 2nd Respiratory Medicine Department Attikon Hospital University of Athens Athens Greece
| | - A. I. Papaioannou
- 2nd Respiratory Medicine Department Attikon Hospital University of Athens Athens Greece
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15
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Papiris SA, Tomos IP, Karakatsani A, Spathis A, Korbila I, Analitis A, Kolilekas L, Kagouridis K, Loukides S, Karakitsos P, Manali ED. High levels of IL-6 and IL-8 characterize early-on idiopathic pulmonary fibrosis acute exacerbations. Cytokine 2017; 102:168-172. [PMID: 28847533 DOI: 10.1016/j.cyto.2017.08.019] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 07/31/2017] [Accepted: 08/21/2017] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Controversy exists about the pathogenesis of idiopathic pulmonary fibrosis acute exacerbations (IPF-AEs). According to one hypothesis IPF-AEs represent the development of any etiology diffuse alveolar damage (DAD) upon usual interstitial pneumonia (UIP), whilst other researchers argue that an accelerated phase of the intrinsic fibrotic process of unknown etiology prevails, leading to ARDS. Different cytokines might be involved in both processes. The aim of this study was to assess pro-inflammatory and pro-fibrotic cytokines in the peripheral blood from stable and exacerbated IPF patients. METHODS Consecutive IPF patients referred to our department were included. Diagnoses of IPF and IPF-AE were based on international guidelines and consensus criteria. The interleukins (IL)-4, IL-6, IL-8, IL-10, and IL-13 as well asactive transforming growth factor-beta (TGF-β) were measured in blood from both stable and exacerbated patients on the day of hospital admission for deterioration. Subjects were followed for 12months. Mann-Whitney test as well as Tobit and logistic regression analyses were applied. RESULTS Among the 41 patients studied, 23 were stable, and 18 under exacerbation; of the latter, 12 patients survived. The IL-6 and IL-8 levels were significantly higher in exacerbated patients (p=0.002 and p=0.046, respectively). An increase in either IL-6 or IL-8 by 1pg/ml increases the odds of death by 5.6% (p=0.021) and 6.7% (p=0.013), respectively, in all patients. No differences were detected for the other cytokines. CONCLUSION High levels of IL-6 and IL-8 characterize early-on IPF-AEs and an increase in the levels of IL-6 and IL-8 associates with worse outcome in all patients. However, as the most representative pro-fibrotic cytokines, TGF-β, IL-10, IL-4 and IL-13 were not increased and given the dualistic nature, both pro-inflammatory and pro-fibrotic of IL-6 further studies are necessary to clarify the enigma of IPF-AEs etiopathogenesis.
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Affiliation(s)
- Spyros A Papiris
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
| | - Ioannis P Tomos
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
| | - Anna Karakatsani
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
| | - Aris Spathis
- Department of Cytopathology, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
| | - Ioanna Korbila
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
| | - Antonis Analitis
- Department of Hygiene, School of Medicine, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece.
| | - Likurgos Kolilekas
- 7th Pulmonary Department and Asthma Center, "Sotiria" Hospital for Chest Diseases, Athens, Greece.
| | - Konstantinos Kagouridis
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
| | - Stylianos Loukides
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
| | - Petros Karakitsos
- Department of Cytopathology, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
| | - Effrosyni D Manali
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece.
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Tomos IP, Manali ED, Karakatsani A, Korbila I, Analitis A, Giouleka P, Papadaki G, Kolilekas L, Kagouridis K, Papaioannou AI, Herodotou Y, Apollonatou V, Loukides S, Papiris SA. AB001. Predictors of mortality in hospitalized patients with idiopathic pulmonary fibrosis-acute exacerbation. Ann Transl Med 2016. [DOI: 10.21037/atm.2016.ab001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Tsilogianni Z, Hillas G, Bakakos P, Aggelakis L, Konstantellou E, Papaioannou AI, Papaporfyriou A, Papiris S, Koulouris N, Loukides S, Kostikas K. Sputum interleukin-13 as a biomarker for the evaluation of asthma control. Clin Exp Allergy 2016; 46:1498. [PMID: 27790845 DOI: 10.1111/cea.12825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tsilogianni Z, Hillas G, Bakakos P, Aggelakis L, Konstantellou E, Papaioannou AI, Papaporfyriou A, Papiris S, Koulouris N, Loukides S, Kostikas K. Sputum interleukin-13 as a biomarker for the evaluation of asthma control. Clin Exp Allergy 2016; 46:923-31. [PMID: 26990030 DOI: 10.1111/cea.12729] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 02/27/2016] [Accepted: 03/05/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Asthma control refers to the extent to which the manifestations of asthma have been reduced or eradicated by treatment. Interleukin-13 (IL-13) has a central role in Th2 response and serves as a possible therapeutic target in uncontrolled asthma. Fraction of exhaled nitric oxide (FeNO) and sputum eosinophils have modest performance in the evaluation of asthma control. OBJECTIVE To assess the diagnostic performance of sputum IL-13 for the evaluation of asthma control and furthermore to investigate the performance of sputum eosinophils and FeNO. METHODS One hundred and seventy patients with asthma were studied. All subjects underwent assessment of asthma control by asthma control test (ACT), lung function tests, FeNO measurement and sputum induction for cell count identification and IL-13 measurement in supernatants. RESULTS IL-13 (pg/mL) levels in sputum supernatant differed significantly among patients with well-controlled asthma and those with not well-controlled asthma [median IQR 78 (66-102) vs. 213 (180-265), P < 0.001]. Receiver operating characteristic (ROC) analysis showed that, for the whole study population, the diagnostic performance of IL-13 was superior to both sputum eosinophils and FeNO levels [area under the curve (AUC) 0.92, 95% CI 0.87 to 0.95 vs. AUC 0.65, 95% CI 0.58 to 0.72 vs. AUC 0.65, 95% CI 0.55 to 0.72, respectively]. CONCLUSION The diagnostic performance of sputum IL-13 was superior to both sputum eosinophils and FeNO levels for the identification of well-controlled asthma. Sputum IL-13 levels could serve as a useful biomarker for asthma control assessment.
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Affiliation(s)
- Z Tsilogianni
- 2nd Respiratory Medicine Department, University of Athens Medical School, Athens, Greece
| | - G Hillas
- 1st Respiratory Medicine Department, University of Athens Medical School, Athens, Greece
| | - P Bakakos
- 1st Respiratory Medicine Department, University of Athens Medical School, Athens, Greece
| | - L Aggelakis
- 1st Respiratory Medicine Department, University of Athens Medical School, Athens, Greece
| | - E Konstantellou
- 1st Respiratory Medicine Department, University of Athens Medical School, Athens, Greece
| | - A I Papaioannou
- 2nd Respiratory Medicine Department, University of Athens Medical School, Athens, Greece
| | - A Papaporfyriou
- 1st Respiratory Medicine Department, University of Athens Medical School, Athens, Greece
| | - S Papiris
- 2nd Respiratory Medicine Department, University of Athens Medical School, Athens, Greece
| | - N Koulouris
- 1st Respiratory Medicine Department, University of Athens Medical School, Athens, Greece
| | - S Loukides
- 2nd Respiratory Medicine Department, University of Athens Medical School, Athens, Greece
| | - K Kostikas
- 2nd Respiratory Medicine Department, University of Athens Medical School, Athens, Greece
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Boura P, Loukides S, Grapsa D, Achimastos A, Syrigos K. The diverse roles of adiponectin in non-small-cell lung cancer: current data and future perspectives. Future Oncol 2015; 11:2193-203. [DOI: 10.2217/fon.15.96] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In recent years, there is growing research interest for the biological role of adipose tissue-derived bioactive factors, mainly including adipokines, in various forms of cancer. Adiponectin (APN) is the most abundant circulating adipokine, and a key mediator of several cancer-related processes, such as cell proliferation, apoptosis, regulation of tumor cell invasion and angiogenesis. In this review we summarize and critically discuss the published literature on the diverse roles of APN in non-small-cell lung cancer, including its implication in lung cancer development, its use as a diagnostic and prognostic biomarker, and its correlation with cancer-related cachexia. The main challenges and future perspectives, mainly with regard to the potential development of APN-targeted therapeutic agents in cancer therapeutics, are also briefly presented and discussed.
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Affiliation(s)
- Paraskevi Boura
- Oncology Unit GPP, ‘Sotiria’ General Hospital, Athens School of Medicine, Mesogion 152, 11527, Athens, Greece
| | - Stylianos Loukides
- Oncology Unit GPP, ‘Sotiria’ General Hospital, Athens School of Medicine, Mesogion 152, 11527, Athens, Greece
| | - Dimitra Grapsa
- Oncology Unit GPP, ‘Sotiria’ General Hospital, Athens School of Medicine, Mesogion 152, 11527, Athens, Greece
| | - Apostolos Achimastos
- Oncology Unit GPP, ‘Sotiria’ General Hospital, Athens School of Medicine, Mesogion 152, 11527, Athens, Greece
| | - Konstantinos Syrigos
- Oncology Unit GPP, ‘Sotiria’ General Hospital, Athens School of Medicine, Mesogion 152, 11527, Athens, Greece
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Emmanouil P, Loukides S, Kostikas K, Papatheodorou G, Papaporfyriou A, Hillas G, Vamvakaris I, Triggidou R, Katafigiotis P, Kokkini A, Papiris S, Koulouris N, Bakakos P. Sputum and BAL Clara cell secretory protein and surfactant protein D levels in asthma. Allergy 2015; 70:711-4. [PMID: 25728058 DOI: 10.1111/all.12603] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 01/25/2023]
Abstract
Clara cell secretory protein (CC16) is associated with Th2 modulation. Surfactant protein D (SPD) plays an important role in surfactant homeostasis and eosinophil chemotaxis. We measured CC16 and SPD in sputum supernatants of 84 asthmatic patients and 12 healthy controls. In 22 asthmatics, we additionally measured CC16 and SPD levels in BAL and assessed smooth muscle area (SMA), reticular basement membrane (RBM) thickness, and epithelial detachment (ED) in bronchial biopsies. Induced sputum CC16 and SPD were significantly higher in patients with severe asthma (SRA) compared to mild-moderate and healthy controls. BAL CC16 and SPD levels were also higher in SRA compared to mild-moderate asthma. CC16 BAL levels correlated with ED, while SPD BAL levels correlated with SMA and RBM. Severity represented a significant covariate for these associations. CC16 and SPD levels are upregulated in SRA and correlate with remodeling indices, suggesting a possible role of these biomarkers in the remodeling process.
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Affiliation(s)
- P. Emmanouil
- 1st Department of Respiratory Medicine; Medical School of National and Kapodistrian University of Athens; ‘Sotiria’ Hospital of Chest Diseases; Athens Greece
| | - S. Loukides
- 2nd Department of Respiratory Medicine; Medical School of National and Kapodistrian University of Athens; ‘Attikon’ Hospital; Athens Greece
| | - K. Kostikas
- 2nd Department of Respiratory Medicine; Medical School of National and Kapodistrian University of Athens; ‘Attikon’ Hospital; Athens Greece
| | | | - A. Papaporfyriou
- 1st Department of Respiratory Medicine; Medical School of National and Kapodistrian University of Athens; ‘Sotiria’ Hospital of Chest Diseases; Athens Greece
| | - G. Hillas
- 1st Department of Respiratory Medicine; Medical School of National and Kapodistrian University of Athens; ‘Sotiria’ Hospital of Chest Diseases; Athens Greece
| | - I. Vamvakaris
- Pathology Department; ‘Sotiria’ Hospital of Chest Diseases; Athens Greece
| | - R. Triggidou
- Pathology Department; ‘Sotiria’ Hospital of Chest Diseases; Athens Greece
| | - P. Katafigiotis
- Pathology Department; ‘Sotiria’ Hospital of Chest Diseases; Athens Greece
| | - A. Kokkini
- Cytology Department; ‘Sotiria’ Hospital of Chest Diseases; Athens Greece
| | - S. Papiris
- 2nd Department of Respiratory Medicine; Medical School of National and Kapodistrian University of Athens; ‘Attikon’ Hospital; Athens Greece
| | - N. Koulouris
- 1st Department of Respiratory Medicine; Medical School of National and Kapodistrian University of Athens; ‘Sotiria’ Hospital of Chest Diseases; Athens Greece
| | - P. Bakakos
- 1st Department of Respiratory Medicine; Medical School of National and Kapodistrian University of Athens; ‘Sotiria’ Hospital of Chest Diseases; Athens Greece
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Rovina N, Dima E, Bakakos P, Tseliou E, Kontogianni K, Papiris S, Koulouris N, Loukides S. Implication of IL‐18 in chronic inflammation of severe refractory asthma. Clin Transl Allergy 2015. [PMCID: PMC4407177 DOI: 10.1186/2045-7022-5-s2-o10] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Nikoletta Rovina
- 1st Department of Pulmonary MedicineSotiriah HospitalAthens Medical SchoolAthenGreece
| | - Efrosini Dima
- Sotiria HospitalAthens Medical School1st Department of Pulmonary MedicineAthensGreece
| | - Petros Bakakos
- Sotiria HospitalAthens Medical School1st Department of Pulmonary MedicineAthensGreece
| | - Eleni Tseliou
- Sotiria HospitalAthens Medical School1st Department of Pulmonary MedicineAthensGreece
| | | | - Spiridon Papiris
- Sotiria HospitalAthens Medical School2nd Department of Pulmonary MedicineAthensGreece
| | - Nikolaos Koulouris
- Sotiria HospitalAthens Medical School1st Department of Pulmonary MedicineAthensGreece
| | - Stylianos Loukides
- Sotiria HospitalAthens Medical School2nd Department of Pulmonary MedicineAthensGreece
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Kontogianni K, Bakakos P, Kostikas K, Hillas G, Papaporfyriou A, Papiris S, Koulouris NG, Loukides S. Levels of prostaglandin E(2) and Cysteinyl-leukotrienes in sputum supernatant of patients with asthma: the effect of smoking. Clin Exp Allergy 2014; 43:616-24. [PMID: 23711123 DOI: 10.1111/cea.12077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 11/27/2012] [Accepted: 11/28/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Smoking is associated with worse asthma outcomes and may modify airway inflammation. Such modification may be mediated through an effect on prostaglandin E(2) (PGE(2)) and cysteinyl leukotrienes (Cyst-LTs). OBJECTIVE We aimed to determine the levels of both PGE(2) and Cyst-LTs in sputum supernatants of patients with asthma and to investigate the effect of smoking habit as well as their associations with inflammatory cells, bronchial hyperresponsiveness (BHR) and lung function. METHODS Ninety-eight patients to asthma (47 smokers) and 40 healthy subjects (20 smokers) were studied. All subjects underwent sputum induction for cell count identification, PGE(2) and Cyst-LTs levels measurement in supernatants, pulmonary function tests and BHR to methacholine. RESULTS Patients with asthma had significantly higher levels of both Cyst-LTs and PGE(2) in sputum supernatants compared to healthy subjects [median (interquartile ranges) 432 (287, 575) vs. 91.5 (73.5, 111) pg/mL and 654 (456,789) vs. 117.5 (92,157) pg/mL, respectively, P < 0.001 for both comparisons]. Smoking asthmatics had significantly higher Cyst-LTs and PGE(2) levels compared to non-smoking asthmatics. Cyst-LTs levels in sputum supernatant of smoking asthmatics presented a significant positive association with sputum eosinophils, while PGE(2) levels were positively associated with sputum neutrophils. CONCLUSIONS The increased concentrations of PGE(2) and Cyst-LTs in sputum supernatants of smoking asthma are consistent with an up-regulation of these two mediators in this specific phenotype of asthma. Furthermore, Cyst-LTs are associated with eosinophilic inflammation, while PGE(2) is associated with the presence of neutrophilic inflammation in smoking asthma.
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Affiliation(s)
- K Kontogianni
- 1st Respiratory Medicine Department, University of Athens Medical School, Sotiria Chest Hospital, Athens, Greece
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Nikolakopoulou S, Hillas G, Perrea D, Tentolouris N, Loukides S, Kostikas K, Simoes D, Georgakopoulou E, Vogiatzakis E, Veldekis D, Bakakos P. Serum angiopoietin-2 and CRP levels during COPD exacerbations. COPD 2013; 11:46-51. [PMID: 24102428 DOI: 10.3109/15412555.2013.829436] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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 AND OBJECTIVE Angiopoietin-2 (Ang-2) is an important mediator of angiogenesis and has been implicated in many inflammatory diseases. COPD is characterized by systemic inflammation, which is enhanced during exacerbations and may be assessed by measuring serum C-reactive protein (CRP). The aim of the study was to evaluate serum CRP and Ang-2 levels on the first (D1) and seventh day (D7) of hospitalization due to a COPD exacerbation and to examine possible associations of CRP and Ang-2 levels and kinetics with the length of hospital stay and outcome. METHODS We conducted a prospective study and evaluated 90 patients admitted to the hospital with a diagnosis of an acute exacerbation of COPD. A venous blood sample was obtained from all patients on D1 and D7 of hospitalization, for the measurement of Ang-2 and CRP. RESULTS Serum Ang-2 levels were significantly higher on D1 compared to D7 during the course of COPD exacerbation (p < 0.001). Serum CRP levels were also significantly higher on D1 compared to D7 (p < 0.001). Serum Ang-2 presented a significant positive correlation with CRP levels both on D1 and D7 (r = 0.315 and r = 0.228, respectively). Patients with unfavorable outcome had significantly higher Ang-2 levels both on D1 (p = 0.04) and D7 (p = 0.01). CONCLUSIONS Serum Ang-2 levels are elevated at the onset of COPD exacerbations and are positively associated with CRP levels. Ang-2 levels decrease during the course of COPD exacerbations in patients with favorable outcome. Serum Ang-2 may serve as a biomarker that could predict the outcome of a COPD exacerbation.
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Affiliation(s)
- Sofia Nikolakopoulou
- 1Department of Respiratory and Critical Care Medicine, Research Unit, "Sotiria" Chest Diseases Hospital , Athens , Greece
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Katsoulis K, Ganavias L, Michailopoulos P, Bikas C, Dinapogias E, Kontakiotis T, Kostikas K, Loukides S. Exhaled nitric oxide as screening tool in subjects with suspected asthma without reversibility. Int Arch Allergy Immunol 2013; 162:58-64. [PMID: 23816757 DOI: 10.1159/000350221] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 02/18/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As fractional exhaled nitric oxide (FeNO) has been evaluated only in certain settings for asthma diagnosis, we investigated whether FeNO values could predict positive methacholine challenge testing (expressed as PD20) in subjects with suspected asthma but without spirometric reversibility. METHODS Subjects with asthma-like symptoms and negative bronchodilation test were initially evaluated to undergo FeNO measurement and methacholine bronchial challenge. Diagnostic performance of FeNO to predict PD20 to methacholine <800 μg was examined by constructing receiver-operating characteristic curves. RESULTS A total of 112 subjects met the inclusion criteria. In all subjects, FeNO >32 ppb was associated with a sensitivity of 0.47 and a specificity of 0.85 for the identification of the PD20 <800 μg (AUC = 0.691, 95% CI = 0.6-0.775, p = 0.00002). In smokers, FeNO >11 ppb was associated with a sensitivity of 0.85 and a specificity of 0.5 for the identification of PD20 <800 μg (AUC = 0.625, 95% CI = 0.45-0.772, p = 0.18), while in atopics a FeNO level >26 ppb was associated with a sensitivity of 0.55 and a specificity of 0.85 (AUC = 0.677, 95% CI = 0.53-0.8, p = 0.02). CONCLUSIONS In subjects with symptoms compatible with asthma but without spirometric reversibility, specific cutoff levels for FeNO levels significantly predict the positive methacholine challenge, with significant confounding factors being atopy and current smoking.
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Affiliation(s)
- K Katsoulis
- Pulmonary Department, 424 General Army Hospital, Thessaloniki, Greece
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Tzouvelekis A, Margaritopoulos G, Loukides S, Bouros D. Warfarin in Idiopathic Pulmonary Fibrosis: Friend or Foe, Is It a Matter of Genes and Heparin? Am J Respir Crit Care Med 2013; 187:213-4. [DOI: 10.1164/ajrccm.187.2.213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Simiakakis M, Kapsimalis F, Chaligiannis E, Loukides S, Sitaras N, Alchanatis M. Lack of effect of sleep apnea on oxidative stress in obstructive sleep apnea syndrome (OSAS) patients. PLoS One 2012; 7:e39172. [PMID: 22761732 PMCID: PMC3382594 DOI: 10.1371/journal.pone.0039172] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 05/16/2012] [Indexed: 11/29/2022] Open
Abstract
Purpose The aim of this study was to evaluate markers of systemic oxidative stress and antioxidant capacity in subjects with and without OSAS in order to investigate the most important factors that determine the oxidant–antioxidant status. Methods A total of 66 subjects referred to our Sleep laboratory were examined by full polysomnography. Oxidative stress and antioxidant activity were assessed by measurement of the derivatives of reactive oxygen metabolites (d-ROMs) and the biological antioxidant capacity (BAP) in blood samples taken in the morning after the sleep study. Known risk factors for oxidative stress, such as age, sex, obesity, smoking, hypelipidemia, and hypertension, were investigated as possible confounding factors. Results 42 patients with OSAS (Apnea-Hypopnea index >15 events/hour) were compared with 24 controls (AHI<5). The levels of d-ROMS were significantly higher (p = 0.005) in the control group but the levels of antioxidant capacity were significantly lower (p = 0.004) in OSAS patients. The most important factors predicting the variance of oxidative stress were obesity, smoking habit, and sex. Parameters of sleep apnea severity were not associated with oxidative stress. Minimal oxygen desaturation and smoking habit were the most important predicting factors of BAP levels. Conclusion Obesity, smoking, and sex are the most important determinants of oxidative stress in OSAS subjects. Sleep apnea might enhance oxidative stress by the reduction of antioxidant capacity of blood due to nocturnal hypoxia.
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Affiliation(s)
- M. Simiakakis
- 1st Department of Respiratory Medicine, Medical School, University of Athens, Sotiria Hospital for Chest Diseases, Athens, Greece
| | - F. Kapsimalis
- 1st Department of Respiratory Medicine, Medical School, University of Athens, Sotiria Hospital for Chest Diseases, Athens, Greece
- * E-mail:
| | - E. Chaligiannis
- Department of Pharmacology, Medical School, University of Athens, Athens, Greece
| | - S. Loukides
- 2nd Department of Respiratory Medicine, Medical School, University of Athens, Athens, Greece
| | - N. Sitaras
- Department of Pharmacology, Medical School, University of Athens, Athens, Greece
| | - M. Alchanatis
- 1st Department of Respiratory Medicine, Medical School, University of Athens, Sotiria Hospital for Chest Diseases, Athens, Greece
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Tseliou E, Bakakos P, Kostikas K, Hillas G, Mantzouranis K, Emmanouil P, Simoes D, Alchanatis M, Papiris S, Loukides S. Increased levels of angiopoietins 1 and 2 in sputum supernatant in severe refractory asthma. Allergy 2012; 67:396-402. [PMID: 22229541 DOI: 10.1111/j.1398-9995.2011.02768.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2011] [Indexed: 12/30/2022]
Abstract
BACKGROUND Airway and vascular remodeling may play a prominent role in the clinical severity of severe refractory asthma (SRA). Angiopoietin-1 (Ang-1) is an essential mediator of angiogenesis by establishing vascular integrity, whereas angiopoietin-2 (Ang-2) acts as its natural inhibitor. OBJECTIVE We aimed to determine the levels of angiopoietins in sputum supernatants of patients with SRA and to investigate the possible associations with mediators and cells involved in both the inflammatory and the vascular remodeling processes. METHODS Thirty-eight patients with SRA, 35 patients with moderate asthma, and 20 healthy subjects were studied. All participants underwent lung function tests, bronchial hyperresponsiveness assessment and sputum induction for cell count identification and Ang-1, Ang-2, VEGF, TGF-β1, Cys-LTs, MMP-2, IL-13, ECP, and IL-8 measurement in supernatants. Airway vascular permeability (AVP) index was also assessed. RESULTS Ang-1 (ng/ml) and Ang-2 (pg/ml) levels were significantly elevated in patients with SRA compared with patients with moderate asthma and control subjects [median, interquartile ranges: 30 (17-39) vs 7.5 (5-11) vs 4.7 (3.8-5.9) respectively, P < 0.001; and 506 (400-700) vs 190 (146-236) vs 96 (89-120) respectively, P < 0.001]. Regression analysis showed a significant positive association between Ang-2 and AVP index, MMP-2, Ang-1, and VEGF in SRA. A weak association was also observed between Ang-1 and sputum eosinophils% in SRA. CONCLUSION Our results indicate that both angiopoietins levels are higher in SRA compared with moderate asthma and healthy subjects. In SRA, Ang-2 is associated with mediators involved in both the inflammatory and the vascular remodeling processes.
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Affiliation(s)
- E. Tseliou
- 2nd Respiratory Medicine Department; University of Athens Medical School; ‘Attikon’ Hospital; Athens; Greece
| | - P. Bakakos
- 1st Respiratory Medicine Department; University of Athens Medical School; ‘Sotiria’ Chest Hospital; Athens; Greece
| | - K. Kostikas
- 2nd Respiratory Medicine Department; University of Athens Medical School; ‘Attikon’ Hospital; Athens; Greece
| | - G. Hillas
- Research Unit; Department of Respiratory and Critical Care Medicine; ‘Sotiria’ Chest Hospital; Athens; Greece
| | - K. Mantzouranis
- 1st Respiratory Medicine Department; University of Athens Medical School; ‘Sotiria’ Chest Hospital; Athens; Greece
| | - P. Emmanouil
- 1st Respiratory Medicine Department; University of Athens Medical School; ‘Sotiria’ Chest Hospital; Athens; Greece
| | - D. Simoes
- G.P Livanos and M. Simou Laboratories; Department of Critical Care and Pulmonary Services; ‘Evangelismos’ Hospital; University of Athens; Medical School; Athens; Greece
| | - M. Alchanatis
- 1st Respiratory Medicine Department; University of Athens Medical School; ‘Sotiria’ Chest Hospital; Athens; Greece
| | - S. Papiris
- 2nd Respiratory Medicine Department; University of Athens Medical School; ‘Attikon’ Hospital; Athens; Greece
| | - S. Loukides
- 2nd Respiratory Medicine Department; University of Athens Medical School; ‘Attikon’ Hospital; Athens; Greece
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Loukides S, Kontogianni K, Hillas G, Horvath I. Exhaled breath condensate in asthma: from bench to bedside. Curr Med Chem 2011; 18:1432-43. [PMID: 21428897 DOI: 10.2174/092986711795328418] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 03/05/2011] [Indexed: 11/22/2022]
Abstract
The need for non-invasive assessment of airway inflammation is imperative, since inflammatory airway diseases, such as asthma and COPD, are characterized by variation in their clinical presentation throughout their course. Exhaled breath condensate (EBC) collection represents a rather appealing method that can be used to conveniently and noninvasively collect a wide range of volatile and non-volatile molecules from the respiratory tract, without affecting airway function or inflammation. Although promising, EBC is currently used only as a research tool, due to the lack of appropriate standardization and the absence of reference values. A large number of mediators of inflammation, oxidative and nitrosative stress, including adenosine, ammonia, hydrogen peroxide, isoprostanes, leukotrienes, prostanoids, nitrogen oxides, peptides and cytokines, have been studied in EBC. This review focuses mainly on the presentation of the above biomarkers in asthma as well as on the effect of various factors on their concentrations. Concentrations of such mediators have been shown to be related to the underlying asthma and its severity and to be modulated by therapeutic interventions. Despite the encouraging positive results up-to-date, the introduction of EBC in everyday clinical practice requires the work-out of some methodological pitfalls, the standardization of EBC collection, and finally the identification of a reliable biomarker which is reproducible, has normal values and provides information for the underlying inflammatory process and the response to treatment. So far none of the parameters studied in EBC fulfils the aforementioned requirements.
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Affiliation(s)
- S Loukides
- 2nd Respiratory Medicine Department, University of Athens Medical School, Athens, Greece.
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Tsigkaropoulou E, Hatzilia D, Rizos E, Christodoulou C, Loukides S, Papiris S, Lykouras L. Venlafaxine-induced acute eosinophilic pneumonia. Gen Hosp Psychiatry 2011; 33:411.e7-9. [PMID: 21762842 DOI: 10.1016/j.genhosppsych.2011.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 03/22/2011] [Accepted: 03/22/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Acute Eosinophilic Pneumonia (AEP) is a severe syndrome which can be potentially induced by many reasons, including drugs. It is characterized by pulmonary infiltrates, peripheral blood eosinophilia and respiratory failure. AEP has rarely been associated with antidepressant treatment. CASE REPORT We report a case of an 80-year-old woman who presented with fever, lung infiltrates, peripheral blood eosinophilia and acute respiratory failure. All evidence charge venlafaxine as the only possible causal factor. The syndrome rapidly resolved after discontinuation of the drug and upon reception of corticosteroids in low doses. The patient had a past medical history of AEP induced by sertraline and a recent medical history of Acute Lung Injury on the context of acute pancreatitis during treatment with venlafaxine. DISCUSSION Pathophysiological mechanisms implicated in the development of AEP in our patient seems to be associated with eotaxin and serotonin eosinophilic-specific chemoattracting action. CONCLUSION This is a case report with clinical adverse reaction of AEP in two antidepressant agents (venlafaxine and sertraline) with a similar neurochemical mechanism of action via the serotoninergic system.
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Affiliation(s)
- Evi Tsigkaropoulou
- National and Kapodistrian University of Athens, Medical School, 2nd Department of Psychiatry, University ATTIKON General Hospital, 12462 Athens, Greece
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30
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Dumitru S, Harikiopoulou M, Theodorakopoulou E, Lagou S, Kavoura P, Tselembis A, Bratis D, Loukides S, Bakakos P, Koulouris N, Roussos C, Kosmas EN. COMPLIANCE OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE TO A PULMONARY REHABILITATION PROGRAM: ITS IMPACT ON THE OUTCOMES AND ITS PROGNOSTICATION. Chest 2009. [DOI: 10.1378/chest.136.4_meetingabstracts.57s-e] [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: 11/01/2022] Open
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31
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Kostikas K, Koutsokera A, Papiris S, Gourgoulianis KI, Loukides S. Exhaled breath condensate in patients with asthma: implications for application in clinical practice. Clin Exp Allergy 2008; 38:557-65. [PMID: 18352973 DOI: 10.1111/j.1365-2222.2008.02940.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Exhaled breath condensate (EBC) analysis, a rather appealing and promising method, can be used to evaluate conveniently and non-invasively a wide range of molecules from the respiratory tract, and to understand better the pathways propagating airway inflammation. A large number of mediators of inflammation, including adenosine, ammonia, hydrogen peroxide, isoprostanes, leukotrienes, prostanoids, nitrogen oxides, peptides and cytokines, have been studied in EBC. Concentrations of such mediators have been shown to be related to the underlying asthma and its severity and to be modulated by therapeutic interventions. Despite the encouraging positive results to date, the introduction of EBC in everyday clinical practice requires the resolution of some methodological pitfalls, the standardization of EBC collection and finally the identification of a reliable biomarker that is reproducible has normal values and provides information regarding the underlying inflammatory process and the response to treatment. So far, none of the parameters studied in EBC fulfils the aforementioned requirements with one possible exception: pH. EBC pH is reproducible, has normal values, reflects a significant part of asthma pathophysiology and is measurable on-site with standardized methodology although some methodological aspects of measurement of pH in EBC (e.g. the effect of ambient CO(2), sample de-aeration, time for pH measurement) require further research. However, EBC pH has not been evaluated prospectively as a guide for treatment, in a manner similar to exhaled NO and sputum eosinophils. EBC represents a simple and totally non-invasive procedure that may contribute towards our understanding of asthma pathophysiology. Besides the evaluation of new biomarkers, the standardization of the already existing procedures is warranted for the introduction of EBC in clinical practice.
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Affiliation(s)
- K Kostikas
- Respiratory Medicine Department, University of Thessaly Medical School, Larissa, Greece
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Gaki E, Papatheodorou G, Ischaki E, Grammenou V, Papa I, Loukides S. Leukotriene E(4) in urine in patients with asthma and COPD--the effect of smoking habit. Respir Med 2006; 101:826-32. [PMID: 16965907 DOI: 10.1016/j.rmed.2006.06.031] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2006] [Revised: 06/04/2006] [Accepted: 06/28/2006] [Indexed: 11/15/2022]
Abstract
Leukotriene E(4) (LTE(4)) is implicated in asthma pathophysiology and possibly in chronic obstructive pulmonary disease (COPD) as one of the causes of persistent bronchoconstriction and mucus hypersecretion. Cigarette smoking stimulates cysteinyl leukotrienes (CysLTs) production. We investigated whether LTE(4) is equally increased in asthma and COPD and whether smoking significantly affects LTE(4) levels. Secondary outcomes involved correlations with inflammatory and functional parameters. We studied 40 patients with COPD [20 smokers], 40 asthmatics [20 smokers] and 30 healthy subjects [15 smokers]. Spirometry (FEV(1)% pred., FEV(1)/FVC) was performed, urine was collected for measurement of LTE(4) and creatinine, induced sputum was collected for differential cell counts and serum for ECP. LTE(4)/creatinine levels (pg/mg) [mean (sd)] were increased in asthmatic patients compared to COPD and controls, [125.6(54.5) vs. 54.5(19) vs. 55.9(18.9)pg/mg, respectively, P<0.0001 for asthma]. Smoking significantly affects LTE(4) levels only in asthmatic patients [164 (48) vs. 87 (26.3), P<0.0001 for smokers]. The only significant correlation was between eosinophils in induced sputum and LTE(4)/creatinine levels in asthmatics. In conclusion, patients with asthma presented higher LTE(4) values compared to normals and patients with COPD. Smoking significantly affects LTE(4) values only in asthmatics indicating a different underlying CysLTs inflammatory process in this condition.
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Affiliation(s)
- E Gaki
- Pneumonology Department, Athens Veterans Hospital, Athens, Greece
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Psathakis K, Mermigkis D, Papatheodorou G, Loukides S, Panagou P, Polychronopoulos V, Siafakas NM, Bouros D. Exhaled markers of oxidative stress in idiopathic pulmonary fibrosis. Eur J Clin Invest 2006; 36:362-7. [PMID: 16634841 DOI: 10.1111/j.1365-2362.2006.01636.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Expired breath condensate (EBC) has never been used to explore the level of oxidative stress in idiopathic pulmonary fibrosis (IPF). Therefore, the aim of this study was to measure the levels of H2O2 and 8-isoprostane, as biomarkers of oxidative stress, in the EBC of patients with IPF. MATERIALS AND METHODS We investigated 16 patients with IPF and 15 healthy subjects as the control group. The levels of H2O2 and 8-isoprostane were measured in the EBC of all subjects and were compared between the IPF and control groups. In patients with IPF, H2O2 and 8-isoprostane were further correlated with pulmonary function tests (PFTs), the resting pO2 and the differential cell count from the bronchoalveolar lavage fluid (BALF). RESULTS The mean (95%CI) concentration of H2O2 was increased in the patients with IPF compared with the normal subjects (0.36, 0.24-0.47 microM vs. 0.16, 0.10-0.23 microM, P=0.003). The mean (95%CI) concentration of 8-isoprostane was also increased in the patients with IPF compared with the controls (74, 38-110 pg mL-1 vs. 33, 28-39 pg mL-1, P=0.02). In the patients with IPF, the diffusing capacity of the lung for carbon monoxide was negatively correlated with the levels of H2O2 in EBC (P=0.03, r=-0.58). No other correlation was found between the oxidative stress markers in the EBC and PFT values, pO2 or BALF cell count. CONCLUSIONS Our data suggest that H2O2 and 8-isoprostane are increased in the EBC of patients with IPF. H2O2 may be correlated with the severity of the disease in IPF.
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Affiliation(s)
- K Psathakis
- Department of Pneumonology and the Clinical Research Unit, Army General Hospital of Athens, and Department of Pneumonology, University Hospital of Heraklion, Greece.
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Horváth I, Hunt J, Barnes PJ, Alving K, Antczak A, Baraldi E, Becher G, van Beurden WJC, Corradi M, Dekhuijzen R, Dweik RA, Dwyer T, Effros R, Erzurum S, Gaston B, Gessner C, Greening A, Ho LP, Hohlfeld J, Jöbsis Q, Laskowski D, Loukides S, Marlin D, Montuschi P, Olin AC, Redington AE, Reinhold P, van Rensen ELJ, Rubinstein I, Silkoff P, Toren K, Vass G, Vogelberg C, Wirtz H. Exhaled breath condensate: methodological recommendations and unresolved questions. Eur Respir J 2005; 26:523-48. [PMID: 16135737 DOI: 10.1183/09031936.05.00029705] [Citation(s) in RCA: 835] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Collection of exhaled breath condensate (EBC) is a noninvasive method for obtaining samples from the lungs. EBC contains large number of mediators including adenosine, ammonia, hydrogen peroxide, isoprostanes, leukotrienes, nitrogen oxides, peptides and cytokines. Concentrations of these mediators are influenced by lung diseases and modulated by therapeutic interventions. Similarly EBC pH also changes in respiratory diseases. The aim of the American Thoracic Society/European Respiratory Society Task Force on EBC was to identify the important methodological issues surrounding EBC collection and assay, to provide recommendations for the measurements and to highlight areas where further research is required. Based on the currently available evidence and the consensus of the expert panel for EBC collection, the following general recommendations were put together for oral sample collection: collect during tidal breathing using a noseclip and a saliva trap; define cooling temperature and collection time (10 min is generally sufficient to obtain 1-2 mL of sample and well tolerated by patients); use inert material for condenser; do not use resistor and do not use filter between the subject and the condenser. These are only general recommendations and certain circumstances may dictate variation from them. Important areas for future research involve: ascertaining mechanisms and site of exhaled breath condensate particle formation; determination of dilution markers; improving reproducibility; employment of EBC in longitudinal studies; and determining the utility of exhaled breath condensate measures for the management of individual patients. These studies are required before recommending this technique for use in clinical practice.
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Affiliation(s)
- I Horváth
- National Korányi Institute for Pulmonology, Dept of Pathophysiology, Budapest PO Box 1, Piheno u. 1. H-1529, Hungary.
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Stathopoulos GP, Veslemes M, Georgatou N, Antoniou D, Giamboudakis P, Katis K, Tsavdaridis D, Rigatos SK, Dimitroulis I, Bastani S, Loukides S, Vergos K, Marossis K, Grigoratou T, Kalatzi E, Charalambatou M, Paspalli A, Michalopoulou P, Stoka M, Gerogianni A. Front-line paclitaxel–vinorelbine versus paclitaxel–carboplatin in patients with advanced non-small-cell lung cancer: a randomized phase III trial. Ann Oncol 2004; 15:1048-55. [PMID: 15205198 DOI: 10.1093/annonc/mdh260] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [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: 11/12/2022] Open
Abstract
PURPOSE This randomized phase III trial of advanced or metastatic non-small-cell lung cancer (NSCLC) was designed to compare a standard treatment such as carboplatin (CRP)-paclitaxel (PCT) with a new combination, vinorelbine (VRL)-PCT-two agents acting in microtubules. PATIENTS AND METHODS Three hundred and sixty patients (stage IIIa, IIIb and IV) were included and evaluated for response rate, survival and toxicity. Arm A patients were treated with the control combination of CRP 6 AUC and PCT 175 mg/m(2) repeated every 3 weeks for six cycles, and arm B with the investigational combination of VRL 25 mg/m(2) and PCT 135 mg/m(2) repeated every 2 weeks for nine cycles. The patients were well balanced with respect to gender, disease stage and performance status. Arm A received 849 cycles (mean 4.59 per patient) and arm B 951 cycles (mean 5.39 per patient). RESULTS Complete and partial response rates were 45.95% and 42.86% for arms A and B, respectively. Median survival was 11 and 10 months, 1-year survival 42.7% and 37.85% and 2-year survival 10.12% and 19% for arms A and B, respectively. Toxicity was similar in all patients, except for neutropenia, which was significantly greater in arm B. CONCLUSIONS PCT combined with VRL produces similar (non-significant) response rates, survival and toxicity (except for neutropenia, as noted above) to standard CRP-PCT treatment in untreated advanced-stage NSCLC.
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Affiliation(s)
- G P Stathopoulos
- First Department of Medical Oncology, Errikos Dynan Hospital, Athens.
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Katsenos S, Kostikas K, Lachanis S, Sabaziotis D, Psathakis K, Loukides S. Simultaneous pulmonary and intrathoracic lymph nodal granulomatosis of unknown significance (GLUS). Monaldi Arch Chest Dis 2004; 61:120-3. [PMID: 15510713 DOI: 10.4081/monaldi.2004.710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A case of a 30-year-old male with a fever, dry cough and associated abnormal findings in imaging modalities (bilateral hilar lymphadenopathy and nodular parenchymal opacities) is described. After a further and scrutinized work-up, the diagnosis of GLUS syndrome was made. Clinical, etiological, pathological and therapeutical aspects of the disease are discussed, demonstrating the paramount importance of the use of the immunohistochemical methods in the diagnosis of this disorder.
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Affiliation(s)
- S Katsenos
- Department of Pneumonology, 401 General Army Hospital of Athens, Athens, Greece
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Abstract
Inhaled prostaglandin (PG)E2 has been found to cause bronchodilation in asthmatics, although it does not have bronchodilative effects in normal subjects. The aim of this study was to investigate the levels of PGE2 in the expired breath condensate of patients with asthma, the possible contribution of smoking habit to its levels and the possible relationship between PGE2 and the degree of bronchial hyperresponsiveness, as assessed by the provocation dose of histamine causing a 20% fall in forced expiratory volume in one second (FEV1) (PD20). A total of 30 mild asthmatics (15 smokers, all steroid-naive, FEV1 88+/-6 (%+/-SD)) and 20 healthy control subjects (10 smokers) were studied. Histamine challenge testing was performed in all subjects and the PD20 was determined. The results showed that asthmatic smokers had significantly higher values of PGE2 compared to asthmatic nonsmokers and control subjects (40+/-21 versus 14.5+/-4.5 versus 11.7+/-3 pg x mL(-1), respectively). Further analysis showed that PGE2 levels were significantly higher in asthmatic smokers compared to smoker and nonsmoker controls (40+/-21 versus 11.6+/-2 versus 11.7+/-4 pg x mL(-1), respectively). No significant difference was observed between asthmatic nonsmokers and both control smokers and control nonsmokers. No significant correlation was found between PGE2 levels and PD20 in all groups of asthmatics, irrespective of smoking habit. In conclusion, the elevation of prostaglandin E2 in the expired breath condensate of patients with asthma is mainly attributed to smoking habit and prostaglandin E2 levels do not predict the degree of bronchial hyperresponsiveness.
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Affiliation(s)
- K Kostikas
- Pneumonology and Clinical Research Dept, Athens Army General Hospital, Athens, Greece
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Psathakis K, Lachanis S, Kotoulas C, Koutoulidis V, Panagou P, Tsintiris K, Loukides S. The prevalence of congenital bronchial atresia in males. Monaldi Arch Chest Dis 2004; 61:28-34. [PMID: 15366333] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Congenital bronchial atresia is a rare anomaly, which usually occurs in adulthood as an incidental finding on routine chest radiograph. METHODS The purpose of the study was to retrospectively evaluate the cases that were diagnosed in our hospital, from January 1995 to March 2003, to estimate the prevalence of this disorder and to determine the diagnostic studies of choice, according to the existing literature. Since the main portion of the male population of our country is referred to our hospital for screening soon after their enrollment in the army, epidemiological data can be easily estimated for many congenital anomalies occuring in adulthood, such as bronchial atresia. RESULTS We found seven patients with Congenital Bronchial Atresia and the prevalence of this disorder was estimated at 1.2 cases per 100,000 in males. The chosen diagnostic procedure is computed tomography of the chest with high-resolution scans. Bronchoscopy would only exclude serious alternative diagnosis and prevent unnecessary surgical interventions. CONCLUSIONS Congenital bronchial atresia is a rare anomaly, with a mild clinical course. The diagnosis is made radiologically, the HRCT of the chest being the procedure of choice. Bronchoscopy should be performed to exclude any endobronchial lesion due to a different disease entity and to prevent unnecessary surgical intervention in an otherwise asymptomatic individual.
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Affiliation(s)
- K Psathakis
- Pneumonology Dept., Army General Hospital, Athens, Greece.
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Horváth I, Loukides S, Wodehouse T, Csiszér E, Cole PJ, Kharitonov SA, Barnes PJ. Comparison of exhaled and nasal nitric oxide and exhaled carbon monoxide levels in bronchiectatic patients with and without primary ciliary dyskinesia. Thorax 2003; 58:68-72. [PMID: 12511725 PMCID: PMC1746449 DOI: 10.1136/thorax.58.1.68] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [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: 02/04/2023]
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is associated with chronic airway inflammation resulting in bronchiectasis. METHODS The levels of exhaled nitric oxide (eNO), carbon monoxide (eCO) and nasal NO (nNO) from bronchiectatic patients with PCD (n=14) were compared with those from patients with non-PCD bronchiectasis without (n=31) and with cystic fibrosis (CF) (n=20) and from normal subjects (n=37) to assess the clinical usefulness of these measurements in discriminating between PCD and other causes of bronchiectasis. RESULTS Exhaled NO levels were lower in patients with PCD than in patients with non-PCD non-CF bronchiectasis or healthy subjects (median (range) 2.1 (1.3-3.5) ppb v 8.7 (4.5-26.0) ppb, p<0.001; 6.7 (2.6-11.9) ppb, p<0.001, respectively) but not lower than bronchiectatic patients with CF (3.0 (1.5-7.5) ppb, p>0.05). Nasal levels of nNO were significantly lower in PCD patients than in any other subjects (PCD: 54.5 (5.0-269) ppb, non-PCD bronchiectasis without CF: 680 (310-1000) ppb, non-PCD bronchiectasis with CF: 343 (30-997) ppb, control: 663 (322-1343) ppb). In contrast, eCO levels were higher in all patient groups than in control subjects (PCD: 4.5 (3.0-24.0) ppm, p<0.01, other bronchiectasis without CF: 5.0 (3.0-15.0) ppm, p<0.001; CF: 5.3 (2.0-23.0) ppm, p<0.001 v 3.0 (0.5-5.0) ppm). Low values in both eNO and nNO readings (<2.4 ppb and <187 ppb, respectively) identified PCD patients from other bronchiectatic patients with a specificity of 98% and a positive predictive value of 92%. CONCLUSION The simultaneous measurement of eNO and nNO is a useful screening tool for PCD.
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Affiliation(s)
- I Horváth
- Department of Thoracic Medicine, National Heart and Lung Institute at Imperial College, London, UK
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42
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Abstract
Production of nitric oxide (NO) is generally increased during inflammatory diseases including asthma. The eventual fate of NO is oxidation to nitrite (NO2) and nitrate (NO3), both of which are end-products of NO metabolism. Hydrogen Peroxide (H2O2) is increased in exhaled breath condensate of asthmatic subjects and may be used as a non-invasive marker of oxidative stress. NO has in some cases been shown to attenuate oxidant-induced lung injury. Total NO2/NO3 concentration and H2O2 levels were measured in expired breath condensate in 50 clinically stable asthmatics [all males, all atopics, mean age 22 (3) SD yrs, forced expiratory volume in 1 sec (FEV1) 91 (10)% predicted, PD20 to histamine 0.262 (0.16) mg 20 on inhaled steroids, 20 smokers, all steroid-naive] and in 10 normal, non-atopic subjects [all males, age 23 (4) yrs, FEV1 101 (14)% predicted, PD20 to histamine 1.3 (0.55) mg]. NO2/NO3 levels were significantly higher in patients with asthma than in normal subjects (1.08, 95% CI 0.86-1.3 microM vs. 0.6; 95% CI 0.46-0.8, P < 0.001). Patients who were on inhaled steroids had significantly ower values compared to steroid-naive (0.71, 95% CI 0.55-0.87 microM vs. 133, 95% CI 1-1.65 microM, P < 0.001). Similar results were observed between smokers and non-smokers (1.11, 95% CI 0.74-1.47 microM vs. 1.77, 95% CI 1.1-24 microM, P < 0.0001). There was a significant positive correlation between NO2/NO3 levels and H2O2 concentration in expired breath condensate (r = 0.48, P < 0.0001). No correlation was observed between NO2/NO3 levels, airway obstruction and bronchial hyper-reactivity as assessed by PD20 to histamine. Total NO2/NO3 levels in expired breath condensate are raised in patients with stable asthma and are significantly related to oxidative stress as assessed by H2O2 concentration. Measurement of expired breath NO2/NO3 and H2O2 levels may be clinically useful in the management of oxidation and inflammation mediated lung injury.
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Affiliation(s)
- K Ganas
- Thoracic Medicine Department, Athens Army General Hospital, Greece
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Poulakis N, Androutsos G, Voucouti N, Paterakis G, Loukides S, Kontozoglou T, Bastas A, Bitsakou C, Provata A, Polyzogopoulos D, Tasiopoulou A. Cytokine production by monocytes/macrophages is normal in patients with alveolar proteinosis: a report of two cases. Respiration 2001; 68:224-5. [PMID: 11287842 DOI: 10.1159/000050498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Panagou P, Loukides S, Tsipra S, Kalogeropoulos N. Suppressive BALF lymphocyte phenotype in a patient with prolonged stable alveolar proteinosis. Respiration 2000; 65:79-82. [PMID: 9523372 DOI: 10.1159/000029230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The case history of a 25-year-old man suffering from idiopathic alveolar proteinosis is described. The patient showed a prolonged stable mild disease and a distinct suppressive phenotypic profile of BALF lymphocytes. Specifically, a low T4/T8 ratio and a high percentage of CD11b+ T8 lymphocytes was found. Correlations with disease expression are made.
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Affiliation(s)
- P Panagou
- Pulmonary Department, Army General Hospital, Athens, Greece
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Zervas E, Loukides S, Papatheodorou G, Psathakis K, Tsindiris K, Panagou P, Kalogeropoulos N. Magnesium levels in plasma and erythrocytes before and after histamine challenge. Eur Respir J 2000; 16:621-5. [PMID: 11106202 DOI: 10.1034/j.1399-3003.2000.16d09.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Previous studies have assessed the protective effect of nebulized magnesium sulphate on bronchial hyperreactivity. This study investigated the effect of histamine challenge on intracellular (erythrocytes) and extracellular (plasma) levels of magnesium and the possible relationship between degree of bronchial hyperreactivity and levels of Mg in plasma and erythrocytes. The authors studied 42 mildly asthmatic patients (10 on inhaled steroids) and 20 healthy subjects. Histamine challenge was performed by the dosimeter method and provocative dose causing a 20% fall in forced expiratory volume in one second (PD20) (FEV1) was calculated. Mg levels were measured with a calmagite colourimetric assay, both at baseline and when FEV1 had fallen by 20%. The results showed that Mg levels in plasma did not significantly change after histamine challenge (from 2.06+/-0.02 mg x dL(-1) to 2.08+/-0.02 mg x dL(-1) respectively, p=0.14). Conversely there was a statistically significant decrease in Mg levels in erythrocytes between these two time points (from 1.84+/-0.02 fmmol x cell to 1.78+/-0.02 fmmol x cell p<0.0001). Similar results were observed when the subgroups were studied separately. There was no significant correlation between PD20, the difference in both magnesium concentrations (baseline-PD20 time) or the initial values of Mg levels in erythrocytes and plasma. To conclude, histamine challenge reduces magnesium levels in erythrocytes while plasma levels remain unchanged. This histamine-induced decrease in magnesium levels occurs regardless of the diagnosis of asthma, and it is not correlated with the degree of bronchial hyperreactivity.
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Affiliation(s)
- E Zervas
- Thoracic Medicine Dept., Athens Army General Hospital, Greece
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Loukides S, Karameris A, Lachanis S, Panagou P, Kalogeropoulos N. Eosinophilic granuloma of the lung presenting as an endobronchial mass. Monaldi Arch Chest Dis 2000; 55:208-9. [PMID: 10948667] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
A 19-yr-old male presented with left lung parahilar consolidation and clinical signs of pneumonia. These symptoms were secondary to an endobronchial mass in the apical segment of the lower lobe. At thoracotomy an apical segment bronchial sleeve resection successfully extirpated what later proved to be an endobronchial eosinophilic granuloma. To the authors' knowledge this is the first case report of an endobronchial eosinophilic granuloma in an adult.
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Affiliation(s)
- S Loukides
- Dept of Thoracic Medicine, Athens Army General Hospital, Greece
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Loukides S, Katsoulis K, Tsarpalis K, Panagou P, Kalogeropoulos N. Serum concentrations of lignocaine before, during and after fiberoptic bronchoscopy. Respiration 2000; 67:13-7. [PMID: 10705256 DOI: 10.1159/000029456] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lignocaine is commonly used for local anesthesia during fiberoptic bronchoscopy (FOB). Several studies have reported the peak serum concentration of lignocaine in relation to time, but most of them did not specify the administered dose of lignocaine gel and its possible correlation with peak serum concentration. OBJECTIVE The aim of our study was to record the plasma concentrations of lignocaine before, during and after FOB and to evaluate whether the doses for nasal and tracheobronchial anesthesia have any correlation with the peak serum concentrations of the drug. METHODS Twelve patients with no comorbid conditions undergoing FOB were studied. Lignocaine was administered as a 2% solution using a larynx syringe, 2% gel (mean dose 182.5 +/- 15 mg) and finally 2% solution through the bronchoscope (mean dose 339 +/- 12 mg). Total dose was 622 +/- 20 mg. Venous blood samples were taken before the beginning of local anesthesia and then at 5, 10, 20, 60, 90 and 120 min thereafter. RESULTS Our results showed that peak plasma concentrations of lignocaine were observed in 8 patients 20 min after the beginning of local anesthesia, in 3 patients 30 min afterwards and in 1 patient 60 min afterwards (2.15 +/- 0.4 microg/ml, 1.9 +/- 0.3 microg/ml, 1. 81 microg/ml, respectively). None of our patients exceeded the critical level of toxicity (5 microg/ml). Both the total and tracheobronchial doses of lignocaine were significantly correlated with peak serum concentration (r = 0.63, p = 0.05 and r = 0.64, p = 0.02, respectively). No correlation was found between the dose for nasal anesthesia and peak serum concentration. No adverse reactions were observed. CONCLUSIONS In conclusion our data show that although the amount of lignocaine used in this study exceeded the recommended highest dose (400 mg) in all patients, no toxic levels were observed. Peak plasma concentrations were found within 20-30 min from the beginning of local anesthesia. The dose for the anesthesia of nasal mucosa represented a significant percentage of the total dose, but did not correlate with the peak serum concentration of the drug.
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Affiliation(s)
- S Loukides
- Department of Thoracic Medicine, Athens Army General Hospital, Athens, Greece.
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Abstract
STUDY OBJECTIVES Interstitial inflammation is a major aggravating factor in fibrosing lung disease associated with scleroderma (FASSc) and cryptogenic fibrosing alveolitis (CFA). Exhaled nitric oxide (NO) production is increased in asthma and bronchiectasis and reflects the degree of inflammation. We investigated whether measuring levels of exhaled NO is valuable in assessing disease activity in patients with CFA and patients with FASSc. MEASUREMENTS AND RESULTS NO levels were measured in 11 patients with CFA (mean age +/- SEM, 58 +/- 12 years old; 5 were male) and 17 patients with FASSc (mean age, 48 +/- 9 years old; 5 were male), and they were compared to BAL cell counts and lung function. Patients with CFA and FASSe had elevated NO levels (11.2 +/-1.0 parts per billion [ppb] and 9.8 +/- 1.0 ppb, respectively; p > 0.05), whereas in a group of 13 nonsmoking normal subjects, the NO levels were not elevated (6.9 +/- 0.5 ppb; p < 0.05). Patients with FASSc (n = 8) who had active BAL (defined as either lymphocytes > 14%, neutrophils > 4%, or eosinophils > 3%) had significantly higher NO levels (13.2 +/- 1.8 ppb), and neutrophil (16.5 +/- 4.0%) and lymphocyte (26.8 +/- 3.4%) BAL cell counts than did patients with FASSc who had inactive BAL (6.7 +/- 1.2 ppb; 1.3 +/- 1.0% and 7.5 +/- 1.3%, respectively; p < 0.05). There was a significant correlation between exhaled NO and lymphocyte cell count in patients with FASSc (r = 0.58; p < 0.05). All patients with CFA had active BAL; however, those treated with corticosteroids (12.9 +/- 1.0% ppb, p < 0.05) had lower NO levels (9.0 +/- 1 ppb) and higher BAL lymphocyte cell couits (16.6 +/- 2.0%) than did those not treated with corticosteroids (7.2 +/- 1.7%; p < 0.05). CONCLUSIONS We conclude that exhaled NO may be a useful addition to BAL cell counts in disease monitoring.
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Affiliation(s)
- P Paredi
- Department of Thoracic Medicine, Imperial College School of Medicine at the National Heart and Lung Institute, London, UK
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Abstract
The aim of this study was to report the clinical and laboratory characteristics of bacterial pneumonia related to measles infection, and also to assess any correlation between severity and time of onset. Four hundred and twenty-four previously healthy young males (age 22+/-2.1 yrs) were hospitalized with typical symptoms and signs of measles. One hundred and twelve (26%) developed bacterial pneumonia on admission (n=41), during their hospital stay (n=20) or days after their discharge (n=51): groups A, B and C, respectively. Single lobar consolidation was the most common finding, accounting for 89% of cases. Pleural effusion was uncommon and associated in half of the cases with empyema. A microbiological diagnosis was made in 81 cases. Streptococcus pneumoniae (65 cases) and Klebsiella pneumoniae (9 cases) were the most commonly identified organisms. Patients from group C had significantly higher values of white blood cell count and erythrocyte sedimentation rate, and lower values of arterial oxygen tension (14+/-0.8 x 10(9) x L(-1), 88+/-4 mm and 6.3+/-0.4 kPa (47+/-3 mmHg), respectively) than the other two groups. There were no deaths during the hospitalization period. The mean duration of hospital stay was 13+/-2.4 days and was longer in the presence of K. pneumoniae infection (19+/-1.6 days). Six patients from group C were admitted to the intensive care unit. In conclusion, these data suggest that bacterial pneumonia associated with measles is not unusual in hospitalized adults, and it seems to be more severe when it occurs days after the onset of rash.
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Affiliation(s)
- S Loukides
- Pulmonary Department, 401 Army General Hospital, Athens, Greece
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Panagou P, Loukides S, Tsipra S, Syrigou K, Anastasakis C, Kalogeropoulos N. Evaluation of nasal patency: comparison of patient and clinician assessments with rhinomanometry. Acta Otolaryngol 1998; 118:847-51. [PMID: 9870632 DOI: 10.1080/00016489850182567] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [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: 10/16/2022]
Abstract
The correlation between the objective measurement of nasal resistance and nasal airflow sensation is usually regarded as poor. The aim of the study was to assess the relation between objective indices of nasal patency, as assessed by the occlusion method (RN) and the Youlten peak nasal inspiratory flow meter (PNIF), with subjective sensations of nasal blockade by either the patient or the clinician in groups of patients with rhinitis, asthma, rhinitis and asthma, nasal septal deformity and ill normal controls. We studied nasal airway patency in 254 subjects (37 women, 217 men), mean age 21 years (range 14-78) by RN and PNIF. Nasal resistance was also measured by the application of Ohm's law for parallel resistors (NRO) by estimating the unilateral resistance separately. Subjective sensation of nasal blockade was assessed either by the patient on a 10-point Borg scale (SUB), or the clinician (CLN) on a 6-point scale (3 for each side of the nose). The latter was done in a controlled fashion with the aid of reference sensations. Adjusting for age, height, smoking status and airway calibre, we found good correlation between RN and CLN (r=0.57, p=10(-4)), whereas the association between RN and SUB was moderate and of borderline significance (r=0.42. p=0.05). By logistic regression analysis, we found that the only independent predictors of abnormal nasal resistance at a cut-off value of 0.30 kPa/l/s were the nasal scores as assessed by the clinician (r-=0.26, odds=2.45). We conclude that PNIF measurement and SUB scores are of limited use as indices of nasal patency, although the latter showed an improved association in comparison to older studies. As there is a necessity for some sort of objective measurement to assess nasal patency, the described clinician evaluation may be clinically useful in place of PNIF, but due to its somewhat subjective nature and its inability to detect milder levels of nasal obstruction it cannot be recommended as an alternative to rhinomanometry.
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Affiliation(s)
- P Panagou
- Thoracic Medicine Department, Army General Hospital, Athens, Greece
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