48 research outputs found
Characteristics of prevalent and new COPD cases in Greece: the GOLDEN study
No full textEirini Mitsiki,1 Eleni Bania,2 Christos Varounis,1 Konstantinos I Gourgoulianis,2 Evangelos C Alexopoulos3 1Medical Department, Novartis Hellas, Athens, 2Department of Respiratory Medicine, Medical School, University of Thessaly, University Hospital of Larissa, Larissa, 3School of Social Sciences, Hellenic Open University, Athens, Greece Background: Greece has one of the highest rates of smoking and chronic obstructive pulmonary disease (COPD) in Europe. Aim: The study aimed to record both the disease characteristics among a sample of Greek COPD patients and the nationwide rates of newly diagnosed COPD cases.Methods: In this noninterventional, epidemiological cross-sectional study, a representative nationwide sample of 45 respiratory centers provided data on the following: 1) the demographic and clinical characteristics of COPD patients and 2) newly diagnosed COPD cases monitored over a period of 6 months by each physician.Results: Data from 6,125 COPD patients were collected. Advanced age (median age: 68 years), male predominance (71.3%), largely overweight status with median body mass index (BMI) =27.5 kg/m2, high percentage of current and ex-smokers (89.8%), and presence of comorbidities (81.9%) were evident in the sample. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 criteria, majority of the COPD patients had moderate or severe airflow limitation (61%). Severity of airflow limitation was significantly associated with older age, male sex, obesity, ex-smoking status, and presence of comorbidity (all P-values <0.001). A total of 61.3% of the patients received medication, mostly bronchodilators (64.4%) and fixed-dose combinations of long-acting β2-agonists and inhaled corticosteroids (39.9%), while 35.9% reported taking medication on demand. The majority (81.1%) of patients reported a preference for fewer inhalations of their bronchodilator therapy. Based on the mixed-effect Poisson model, the rate of newly diagnosed COPD cases was estimated to be 18.2% (95% confidence interval: 14.9–22.3) per pulmonologist/3 months. Of those newly diagnosed, the majority of patients had mild or moderate airflow limitation (78.2%).Conclusion: The Greek Obstructive Lung Disease Epidemiology and health ecoNomics study reflected the real-life profile of COPD patients and provided evidence on the profile of new COPD cases in Greece. Various demographic factors were delineated, which can assist in designing more effective diagnostic and management strategies for COPD in Greece. Keywords: COPD, characteristics, newly diagnosed, epidemiology, prevalent cases, new cases, health care system, health care management, nationwide sampling 
Frequency and risk factors of COPD exacerbations and hospitalizations: a nationwide study in Greece (Greek Obstructive Lung Disease Epidemiology and health ecoNomics: GOLDEN study)
No full textEvangelos C Alexopoulos,1 Foteini Malli,2 Eirini Mitsiki,3 Eleni G Bania,2 Christos Varounis,3 Konstantinos I Gourgoulianis1 1School of Social Sciences, Hellenic Open University, Patras, 2Respiratory Medicine Department, University of Thessaly Medical School, University Hospital of Larissa, Larissa, 3Medical Department, Novartis Hellas, Athens, Greece Background: COPD exacerbations and hospitalizations have been associated with poor prognosis for the COPD patient.Objective: To evaluate the frequency and risk factors of COPD exacerbations, hospitalizations, and admissions to intensive care units (ICUs) in Greece by a nationwide cross-sectional study.Materials and methods: A nationwide observational, multicenter, cross-sectional study was conducted in the clinical practice setting of respiratory medicine physicians over a 6 month-period (October 2010 to March 2011). A total of 6,125 COPD patients were recruited by 199 respiratory physicians.Results: Participants had a median age of 68.0 years, 71.3% were males, and 71.8% suffered from comorbidities. The median disease duration was 10.0 years. Of the patients, 45.3% were classified as having GOLD (Global initiative for chronic Obstructive Lung Disease) stage III or IV COPD. Patients with four or more comorbidities had 78.5% and threefold-higher than expected number of exacerbations and hospitalizations, respectively, as well as fivefold-higher risk of admission to the ICU compared to those with no comorbidities. Obese patients had 6.2% fewer expected exacerbations compared to those with a normal body mass index. Patients with GOLD stage IV had 74.5% and fivefold-higher expected number of exacerbations and hospitalizations, respectively, and nearly threefold-higher risk of admission to the ICU compared to stage I patients. An additional risk factor for exacerbations and hospitalizations was low compliance with treatment: 45% of patients reported forgetting to take their medication, and 81% reported a preference for a treatment with a lower dosing frequency.Conclusion: Comorbidities, disease severity, and compliance with treatment were identified as the most notable risk factors for exacerbations, hospitalizations, and ICU admissions. The results point to the need for a multifactorial approach for the COPD patient and for the development of strategies that can increase patient compliance with treatment. Keywords: COPD, exacerbations, hospitalizations, ICU admissions, risk factor
The prognostic significance of atrial arrhytmias recorded early after cardioversion for atrial fibrillation
No full textBackground Atrial fibrillation (AF) has a high risk of recurrence after electrical cardioversion (CV)The purpose of our study was to investigate prognostic factors, such as heart rate (HR) and atnalarrhythmias, measured during Holter recording for 24 hours after CVMethods We prospectively studied 117 consecutive patients (pts) (mean age±S D 61 6 ±10,8 years)subjected to CV, who successfully converted to sinus rhythm All underwent echocardiography and 24hour Holter after CV The majority of pts (60,7%) folio wed-up for one yearResults Thirty-seven pts (31 6%) recurred to AF during the first year of follow-up (group I) Thirty-fourpts (29 1%) remained in sinus rhythm at one year (group II) During one month of follow-up, 22 pts(18,8%) recurred to AF (group III) and the rest remained in sinus rhythm (group IV) Age, gender,underlying disease, left atrium size, fractional shortening, duration of AF and the medication taken weresimilar between the two groups (All P-values=NS) Group I had more atrial premature complexes perhour (APC/h) compared with group II and more APC/h in the first and second six-hour segment of theHolter (P10 APC/h hadhigh specificity but low sensitivity (91 2% και 32 4% respectively) Group III had more atnal prematurecomplexes per hour (APC/h) compared with pts of group IV and more APC/h in the first and second sixhoursegment of the Holter (P=0 002, P=0 057 and P=0 013, respectively) Cut-off analysis showed thatpts with more than 32 APC/h had 10 times higher risk of AF recurrence (OR=10 4 with 95% C 1=2 3-47 4) (sensitivity=75% specificity=77%) Group III pts had higher maximum, average and minimumheart rate compared to group IV (P=0 0013, P=0 0221 and P=0 0331, respectively) Cut-off analysisrevealed that pts with maximum heart rate (Max HR) more than 90 5 bpm had 6 7 times higher risk of AFrecurrence (OR=6 68 with 95% C 1=1 3-34 9) (sensitivity=69% specrficity=78%) Pts with combinationof Max HR more than 90 5 bpm and more than 32 APC/h had 25 2 times higher risk of AF relapse(OR=25 2 with 95% C 1=1 8-352 5)Conclusions Simple 24hour Holter may help to identify pts at higher risk of AF recurrence after CV.Σκοπός Μελετήσαμε την προγνωστική άξια των κολπικών αρρυθμιών και της καρδιακήςσυχνότητας, που καταγράφονται με ενα Holter 24ωρης καταγραφής αμέσως μετά απο επιτυχήηλεκτρική καρδιοαναταξη, ως προς την υποτροπή της αρρυθμίαςΜέθοδοι Μελετήσαμε 117 διαδοχικούς ασθενείς (μέση ηλικία ± SD 61,6±10,8 ετη, 53,8%άνδρες), οι οποίοι υπεβλήθησαν σε επιτυχή ηλεκτρική καρδιοαναταξη για KM Σε όλους τουςασθενείς τοποθετήθηκε Holter 24ωρης καταγραφής μετά απο την ηλεκτρική καρδιοαναταξη Το60,7% των ασθενών παρακολουθήθηκε για ενα έτος Οι υπόλοιποι ασθενείς παρακολουθήθηκανγια ενα μήναΑποτελέσματα Τριαντα-επτα (31,6%) ασθενείς υποτροπίασαν σε KM κατά τη διάρκεια τουπρώτου έτους παρακολούθησης (ομάδα Ι) Τριαντα-τεσσερις ασθενείς (29,1%) παρέμειναν σεφλεβοκομβικο ρυθμό το πρώτο έτος (ομάδα Π) Εικοσι-δυο ασθενείς (18,8%) υποτροπίασαν σεKM κατά τη διάρκεια του πρώτου μήνα παρακολούθησης (ομάδα III) Οι υπόλοιποι ασθενείςπαρέμειναν σε φλεβοκομβικο ρυθμό τον πρώτο μήνα (ομάδα IV) Οι ασθενείς της ομάδας Ισυγκρινόμενη με την ομάδα II είχαν μεγαλύτερο αριθμό έκτακτων κολπικών συστολών ανα ωρα(APC/h) για το σύνολο της καταγραφής Holter, για το πρώτο εξάωρο και για το δεύτερο εξάωρο(Ρ10 APC/h και η παρουσία SVT είχε υψηλήειδικότητα άλλα χαμηλή ευαισθησία (91,2% και 32,4% αντίστοιχα) Οι ασθενείς της ομάδας IIIσυγκρινόμενη με την ομάδα IV είχαν μεγαλύτερο αριθμό APC/h για το σύνολο της καταγραφήςHolter, για το πρώτο εξάωρο και για το δεύτερο εξάωρο (Ρ=0,002, Ρ=0,057 και Ρ=0,013,αντίστοιχα) Οι ασθενείς της ομάδας III συγκρινόμενη με την ομάδα IV είχαν μεγαλύτερη μέγιστη(max HR), μέση και ελάχιστη καρδιακή συχνότητα (Ρ=0,0013 Ρ=0 0221 και Ρ=0 0331αντίστοιχα) Οι ασθενείς με max HR>90,5 bpm είχαν 6,6 μεγαλύτερο κίνδυνο υποτροπής της KM(OR=6,68 με 95% CI 1 3-34,9) τον πρώτο μήνα (ευαισθησια=69%, ειδικοτητα=78%) Οσυνδυασμός max HR>90,5 bpm και >32 APC/h είχε 25,2 μεγαλύτερη πιθανότητα υποτροπής τηςKM τον πρώτο μήνα (OR=25,2 με 95% C Ι 1,8-352,5)Συμπεράσματα Με ενα απλό Holter 24ωρου μπορούμε να αναγνωρίσουμε ασθενείς με υψηλόκίνδυνο υποτροπής της κολπικής μαρμαρυγής μετά απο την ηλεκτρική καρδιοαναταξη
E-selectin, resistin and reactive oxygen species levels in GnRH -agonist and -antagonist protocols in IVF/ICSI: A prospective cohort study
No full textPurpose To compare E-selectin, resistin and reactive oxygen species (ROS) levels in serum and follicular fluid (FF) of subfertile women undergoing Controlled Ovarian Hyperstimulation (COH) during IVF/ICSI cycles, using GnRH-agonist and -antagonist protocols. Methods In this prospective cohort study, 85 subfertile women undergoing IVF/ICSI were included. Participants underwent the GnRH-agonist and -antagonist protocols; and blood samples were collected at three time points: basic (at start of COH), on the day of hCG and at oocyte retrieval (OR); and from the FF from the first follicle aspirate. Clinical and IVF cycle characteristics, were compared between groups, together with the levels of E-selectin, resistin and ROS in serum and FF, through ELISA. Their prognostic value on pregnancy outcomes was examined. Result(s) Examining molecules levels are increasing in serum, from start of COH until OR, irrespectively of the protocol used; FF levels at OR were similar to those in serum at that day. Resistin FF levels were lower in GnRH agonists, compared with the antagonist protocol. Resistin levels at start of COH were associated with clinical pregnancy rates, and this remained significant following adjustment for age, BMI and IVF protocol used, while values of >13.5 ng/ml were associated with a six times greater odd of a pregnancy. Conclusion E-selectin, resistin and ROS levels are increasing during COH, reaching their highest values at OR, with comparable values measured in the FF at that time. Resistin values >13.5 ng/ml are linked with a 6-fold increase on the odds of a pregnancy. © Springer Science+Business Media New York 2015
Congenital left ventricular aneurysm: A cause of impaired myocardial torsion and peripheral thrombo-embolic events
No full textCongenital aneurysms of the left ventricle (LV) are rare cardiac abnormalities and in most instances, are asymptomatic. However, some patients may present cardiac rupture, tamponade, ventricular arrhythmias, and eventually sudden death. Herein, we describe a case of a 64-year-old male patient who was hospitalized for critical limb ischaemia because of an acute embolic event. Transthoracic contrast echocardiography revealed a congenital aneurysm of the LV apex with a small thrombus and a reduced LV ejection fraction. Speckle tracking imaging showed an impaired myocardial torsion. Diagnosis was confirmed after surgical resection of the aneurysm. LV torsion and ejection fraction were normalized after surgery. © 2010 The Author
B-type natriuretic peptide vs. cardiac risk scores for prediction of outcome following major orthopedic surgery
No full textAims: The clinical role of B-type natriuretic peptide (BNP) in preoperative evaluation is not clear. We designed a prospective study to investigate the predictive value of BNP in comparison with established clinical risk scores for the outcome of major orthopedic surgery. Methods: Overall 242 elderly patients [80 (74-85) years] undergoing orthopedic surgery were included. Inhospital cardiovascular events and 1-year mortality were the main endpoints. Results: In total 20 (8.3%) patients had major cardiovascular events (MACE) and 41 (21.1%) died in 1 year. Logistic regression analysis for prediction of cardiac events and 1-year mortality, respectively, revealed a significant prognostic value for the BNP (P < 0.001 and P = 0.041), Goldman (P = 0.013 and P = 0.003), Lee (P = 0.022 and P = 0.200), Detsky (P < 0.001 and P < 0.001), and functional capacity indices (P = 0.034 and P = 0.001). BNP cutoff 149 ng/ml improved discrimination of all scores to predict MACE, and BNP cutoff 89 ng/ml improved discrimination of all scores to predict 1-year mortality (Net Reclassification Improvement, P values < 0.05 in all cases). Age [hazard ratio (HR): 1.100, 95% confidence interval (CI): 1.039-1.166, P = 0.001] and BNP (HR: 1.002, 95% CI: 1.000-1.003, P = 0.041) were independent associates of 1-year mortality. Conclusion: Preoperative levels of BNP compare favorably with the Goldman, Lee, Detsky, and functional capacity indices for prognosis of orthopedic surgery. Implementation of natriuretic peptides in cardiac risk scores is promising.Spyridon Katsanos, Dimitrios Babalis, Nikolaos Kafkas, Andreas Mavrogenis, Darryl Leong, John Parissis, Christos Varounis, Konstantinos Makris, Asfke van der Heijden, Maria Anastasiou-Nana, Gerasimos Filippato
Evaluation of the medication process in pediatric patients: A meta-analysis
No full textObjective to meta-analyze studies that have assessed the medication errors rate in pediatric patients during prescribing, dispensing, and drug administration. Sources searches were performed in the PubMed, Cochrane Library, and Trip databases, selecting articles published in English from 2001 to 2010. Summary of the findings a total of 25 original studies that met inclusion criteria were selected, which referred to pediatric inpatients or pediatric patients in emergency departments aged 0-16 years, and assessed the frequency of medication errors in the stages of prescribing, dispensing, and drug administration. Conclusions the combined medication error rate for prescribing errors to medication orders was 0.175 (95% Confidence Interval: [CI] 0.108-0.270), the rate of prescribing errors to total medication errors was 0.342 (95% CI: 0.146-0.611), that of dispensing errors to total medication errors was 0.065 (95% CI: 0.026-0.154), and that ofadministration errors to total medication errors was 0.316 (95% CI: 0.148-0.550). Furthermore, the combined medication error rate for administration errors to drug administrations was 0.209 (95% CI: 0.152-0.281). Medication errors constitute a reality in healthcare services. The medication process is significantly prone to errors, especially during prescription and drug administration. Implementation of medication error reduction strategies is required in order to increase the safety and quality of pediatric healthcare. © 2014 Sociedade Brasileira de Pediatria
Metabolomics for improving pregnancy outcomes in women undergoing assisted reproductive technologies
No full textThis is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate the effectiveness of metabolomics in improving pregnancy outcomes in women undergoing ART. © 2015 The Cochrane Collaboration
Rising trends in Takotsubo syndrome during the COVID-19 pandemic: A single center experience
No full textThe potential of novel peptides in the management of children with Congenital Heart Disease: Above and beyond the BNP
No full textCongenital Heart Disease (CHD) constitutes a common cause of major congenital abnormalities with prevalence around 8.2 per 1000 live births in Europe. Despite the important advances in the diagnosis, treatment and management of CHD patients throughout the years, it remains a challenge how to better manage the children with CHD using the biomarkers. However, in the last decade, B-type Natriuretic Peptide (BNP) and less often Adrenomedullin (ADM) and Urotensin II (UT II) have become the focus of research, in view of the improvement in the management of patients with CHD. Moreover, despite crescent evidences supporting the use of BNP as diagnostic and prognostic marker in children with CHD, its use remains limited and guidelines/expert consensus recommendations are lacking. Adrenomedullin (ADM) and Urotensin II (UT II) are two potent vasoactive peptides that might play a role in the development of pulmonary hypertension. Future studies are needed to explore the role of both peptides as biomarkers of pulmonary hypertension and their prognostic significance on the development of pulmonary hypertension in CHD patients. © 2016 Elsevier Ireland Lt
