Coronary Artery Disease, Nicotine Addiction, and Depression: The Tragic Triad

A great number of diseases are directly related to active smoking. In the recent years more and more malignant neoplasms were causally related to active smoking. Lung cancer is the “leader” of smoking-related neoplasm’s and the 3rd cause of death in high-income countries, followed by cancer of the oral cavity/pharynx, laryngeal, esophageal, stomach, pancreatic, kidney, bladder, cervical cancer, leukemia and othermalignant neoplasm’s. Among other diseases, cardiovascular and respiratory diseases are also causally related to cigarette smoking. According to World Health Organization (WHO), 5 out of 6 leading causes of death world wide (Ischemic heart disease, cerebrovascular disease, HIV/AIDS, COPD, lower respiratory infections trachea, bronchus, lung cancers) are smoke related... (excerpt

Heterogeneity of blood flow and metabolism during exercise in patients with chronic obstructive pulmonary disease.

The study investigated whether the capacity to regulate muscle blood flow (Q) relative to metabolic demand (VO2) is impaired in COPD. Using six NIRS optodes over the upper, middle and lower vastus lateralis in 6 patients, (FEV1:46 ± 12%predicted) we recorded from each: a) Q by indocyanine green dye injection, b) VO2/Q ratios based on fractional tissue O2 saturation and c) VO2 as their product, during constant-load exercise (at 20%, 50% and 80% of peak capacity) in normoxia and hyperoxia (FIO2:1.0). At 50 and 80%, relative dispersion (RD) for Q, but not for VO2, was greater in normoxia (0.67 ± 0.07 and 0.79 ± 0.08, respectively) compared to hyperoxia (0.57 ± 0.12 and 0.72 ± 0.07, respectively). In both conditions, RD for VO2 and Q significantly increased throughout exercise; however, RD of VO2/Q ratio was minimal (normoxia: 0.12–0.08 vs hyperoxia: 0.13–0.09). Muscle Q and VO2 appear closely matched in COPD patients, indicating a minimal impact of heterogeneity on muscle oxygen availability at submaximal levels of exercise

Limitation in tidal volume expansion partially determines the intensity of physical activity in COPD

open8In patients with Chronic Obstructive Pulmonary Disease (COPD) reduced levels of daily physical activity are associated with the degree of impairment in lung, peripheral muscle and central hemodynamic function. There is however, limited evidence as to whether limitations in tidal volume expansion also, importantly determine daily physical activity levels in COPD. Eighteen consecutive COPD patients [9 active (FEV1:1.59±0.64 liters) with an average daily movement intensity >1.88 m/sec(2) and 9 less active patients (FEV1:1.16±0.41 liters) with an average intensity <1.88 m/sec(2)] underwent a 4-min treadmill test at a constant speed corresponding to each individual patient's average movement intensity, captured by a triaxial accelerometer during a preceding 7-day period. When chest wall volumes, captured by Optoelectronic Plethysmography, were expressed relative to comparable levels of minute ventilation (ranging between 14.5±4.3 to 33.5±4.4 liters/min), active patients differed from the less active ones in terms of the lower increase in end-expiratory chest wall volume (by 0.15±0.17 versus 0.45±0.21 liters), the greater expansion in tidal volume (by 1.76±0.58 versus 1.36±0.24 liters) and the larger inspiratory reserve chest wall volume (IRVcw: by 0.81±0.25 versus 0.39±0.27 liters). IRVcw (r(2)=0.420), expiratory flow (r(2) change=0.174) and Borg dyspnoea score (r(2) change=0.123) emerged as the best contributors accounting for 71.7\% of the explained variance in daily movement intensity. COPD patients exhibiting greater ability to expand tidal volume and to maintain adequate inspiratory reserve volume tend to be more physically active. Thus, interventions aiming at mitigating restrictions on operational chest wall volumes are expected to enhance daily physical activity levels in COPD.openE. A. Kortianou;A. Aliverti;Z. Louvaris;M. Vasilopoulou;I. Nasis;A. Asimakos;S. G. Zakynthinos;I. VogiatzisE. A., Kortianou; Aliverti, Andrea; Z., Louvaris; M., Vasilopoulou; I., Nasis; A., Asimakos; S. G., Zakynthinos; I., Vogiatzi

Pulmonary Hypertension Due to Chronic Thromboembolic Disease Complicated with Hemoptysis and Infection

A 45 year old woman developed exertional dyspnea after surgical removal of uterine fibroids. Heart ultrasound suggested the presence of right heart enlargement and stress due to pulmonary arterial hypertension, whereas the subsequent CT angiography revealed pulmonary embolism. Anticoagulants were initiated. Perfusion defects were noticeable in lung perfusion scan 6 months after the initiation of anticoagulant therapy, while CT angiography was negative for pulmonary embolism. The diagnosis of chronic thromboembolic pulmonary hypertension was initially set and subsequently confirmed by right heart catheterization. Deterioration of dyspnea and right heart dysfunction led to administration of intravenous epoprostenol through a tunneled central venous catheter. After 6 months the patient was admitted to the intensive care unit with fever, hemoptysis, lung infiltrates, and acute-on-chronic hypoxemic respiratory failure. Bronchial artery embolization, oxygen therapy, and antibiotics led to clinical improvement

Long COVID-19 Pulmonary Sequelae and Management Considerations

The human coronavirus 2019 disease (COVID-19) and the associated acute respiratory distress syndrome (ARDS) are responsible for the worst global health crisis of the last century. Similarly, to previous coronaviruses leading to past pandemics, including severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS), a growing body of evidence support that a substantial minority of patients surviving the acute phase of the disease present with long-term sequelae lasting for up to 6 months following acute infection. The clinical spectrum of these manifestations is widespread across multiple organs and consists of the long-COVID-19 syndrome. The aim of the current review is to summarize the current state of knowledge on the pulmonary manifestations of the long COVID-19 syndrome including clinical symptoms, parenchymal, and functional abnormalities, as well as highlight epidemiology, risk factors, and follow-up strategies for early identification and timely therapeutic interventions. The literature data on management considerations including the role of corticosteroids and antifibrotic treatment, as well as the therapeutic potential of a structured and personalized pulmonary rehabilitation program are detailed and discussed

Prevalence of Overweight and Obesity Among Greek Army Recruits

OBJECTIVE Obesity poses a major public health issue whose prevalence is reaching epidemic proportions, especially among younger ages. Our aim was to determine the prevalence of overweight and obesity among Greek men recruited in the army, and to evaluate potential associations with place of residence and educational level. SUBJECTS &amp; METHODS Height and weight were measured in 3,684 men, aged 23.2±2.8 (mean ± standard deviation) years. Body mass index (BMI, kg/m2) was used as measure of adiposity. Associations between BMI categories and level of education (≤9 school years, &gt;9 years) and between BMI categories and place of residence (urban, rural) were evaluated using chi-square test. RESULTS Average BMI was 25.2±4 kg/m2. The prevalence of overweight (25&lt;BMI&lt;30) was 33.7% and associated positively with a higher educational level (p&lt;0.001), whereas the prevalence of obesity (BMI&gt;30) was 10.0% and was not associated with educational level. Obesity was associated with place of residence; individuals from rural areas were more obese than those from urban areas (p=0.04). Our results, when compared to those of similar studies conducted in 1969, 1990, and 2006 showed a significant increase in mean BMI. CONCLUSION Overall, we documented a high and increasing prevalence of overweight and obesity (43.7%) among younger Greek men

Greater exercise tolerance in COPD during acute interval, compared to equivalent constant‐load, cycle exercise: physiological mechanisms

The relative importance of ventilatory, circulatory and peripheral muscle factors in determining tolerance to exercise in patients with COPD is not known. In twelve COPD patients (FEV1 :58 ± 17%pred.) we measured ventilation, cardiac output, dynamic hyperinflation, local muscle oxygenation, blood lactate and time to exhaustion during a) interval exercise (IE) consisting of 30 s at 100% peak work-rate alternated with 30 s at 50% and b) constant load exercise (CLE) at 75% WRpeak, designed to produce the same average work rate. Exercise time was substantially longer during IE than CLE (19.5 ± 4.8 versus 11.4 ± 2.1 min, p = 0.0001). Total work output was therefore greater during IE than CLE (81.3 ± 27.7 versus 48.9 ± 23.8 kJ, p = 0.0001). Dynamic hyperinflation (assessed by changes from baseline in inspiratory capacity-ΔIC) was less during IE than CLE at CLE exhaustion time (isotime, p = 0.009), but was similar at exhaustion (ΔICCLE : -0.38 ± 0.10 versus ΔICIE : -0.33 ± 0.12 l, p = 0.102). In contrast, at isotime, minute ventilation, cardiac output and systemic oxygen delivery did not differ between protocols (p>0.05). At exhaustion in both protocols, vastus lateralis and intercostal muscle oxygen saturation were higher in IE than CLE (p = 0.014 and p = 0.0002, respectively) and blood lactate concentrations were lower (4.9 ± 2.4 mmol/l versus 6.4 ± 2.2 mmol/l, p = 0.039). These results suggest that 1) exercise tolerance in COPD is limited by dynamic hyperinflation; and 2) cyclically lower (50%) effort intervals in IE help preserve muscle oxygenation and reduce metabolic acidosis compared to CLE at the same average work rate, but these factors do not appear to determine time to exhaustion

Tuberculosis Notifications and Mortality in Greece During the Period of 2003 to 2012

Dear Editor,According to the latest World Health Organization report the rate of new tuberculosis (TB) cases has been falling worldwide for over a decade.1 However, TB continues to be a major global public health problem (in 2013, an estimated 9.0 million people developed TB and 1.5 million died from the disease) and surveillance is an essential part of any TB control plan.1 There is evidence that financial crisis can influence tuberculosis incidence and mortality.2 Greece is considered a low incidence country for TB. However, since the final quarter of 2008, Greece has entered the most serious financial downturn in the country’s modern history and this has posed major threats to the health of the population.3 Rates of several communicable diseases have also increased.4 Specifically, an HIV outbreak among intravenous drug users occurred in 2011 and worsened in 2012, increasing the total number of HIV infections reported in Greece from 530 in 2010 to 826 in 2011 and 1,001 in 2012.5 Furthermore, many previously rare or absent infections have also now been reported, including malaria in 2011 and 2012 (previously absent since 1974),West Nile virus in 2010-2012 (never previously reported) and rabies in 2012 (previously absent since 1987).4 In view of this financial crisis we sought to evaluate the potential impact of the financial crisis on the notification rate and the mortality due to TB among the whole Greek population... (excerpt

The immune response of patients with Chronic Obstructive Pulmonary Disease to resistive breathing.

Whole body Exercise (WBE) changes lymphocyte subset percentages in peripheral blood. Resistive breathing, a hallmark of diseases of airway obstruction, is a form of exercise for the inspiratory muscles. Strenuous muscle contractions induce oxidative stress that may mediate immune alterations following exercise. We hypothesized that Inspiratory Resistive Breathing (IRB) alters peripheral blood lymphocyte subsets and that oxidative stress mediates lymphocyte subpopulation alterations following both WBE and IRB. Six healthy non-athletes performed two WBE and two IRB sessions for 45 minutes at 70% of VO2max and 70% of maximum inspiratory pressure (Pi,max) respectively before and after the administration of antioxidants (Vitamins E, A and C for 75 days, allopurinol for 30 days and N-acetylcysteine for 3 days). Blood was drawn at baseline, at the end of each session and 2 hours into recovery. Lymphocyte subsets were determined by flow-cytometry. Before antioxidant supplementation at both WBE and IRB end the Natural Killer (NK) cell percentage increased, the T helper cell (Cluster of Deferentiation-CD3+CD4+) percentage was reduced and the CD4/CD8 ratio was depressed, a response which was abolished by antioxidants only after IRB. Furthermore at IRB end antioxidants promoted CD8+CD38+ and blunted cytotoxic T cell percentage increase. CD8+CD45RA+ cell percentage changes were blunted after antioxidants in both WBE and IRB. We conclude that IRB produces (similar to WBE) changes in peripheral blood lymphocytes subsets and that oxidative stress is a major stimulus predominantly for IRB induced lymphocyte subset alterations.Η ολοσωματική άσκηση (Whole body Exercise -WBE) μεταβάλει τους υποπληθυσμούς των λεμφοκυττάρων στο περιφερικό αίμα. Η αναπνοή μέσα από αντιστάσεις, χαρακτηριστική στα αποφρακτικά αναπνευστικά νοσήματα, αποτελεί μια μορφή άσκησης των αναπνευστικών μυών. Έγινε η υπόθεση ότι η αναπνοή μέσα από εισπνευστική αντίσταση (Inspiratory Resistive Breathing -IRB) μεταβάλει τους υποπληθυσμούς των λεμφοκυττάρων του περιφερικού αίματος και ότι το οξειδωτικό στρες επάγει τις αλλαγές που συμβαίνουν στους υποπληθυσμούς των λεμφοκυττάρων τόσο μετά από την ολοσωματική άσκηση όσο και μετά από την άσκηση των αναπνευστικών μυών (IRB).Για να ελεγχθεί η ανωτέρω υπόθεση διεξήχθη το εξής πείραμα: Έξι υγιείς εθελοντές που δεν ήταν αθλητές υπεβλήθησαν σε 2 συνεδρίες ολοσωματικής άσκησης για 45 λεπτά στο 70% της μέγιστης κατανάλωσης οξυγόνου (VO2max) και 2 συνεδρίες αναπνοής μέσα από εισπνευστική αντίσταση στο 70% της μέγιστης εισπνευστικής πίεσης (maximum inspiratory pressure - Pi,max) πριν και μετά τη χορήγηση αντιοξειδωτικών. Το αντιοξειδωτικό σχήμα που χορηγήθηκε περιελάμβανε: βιταμίνες Α, Ε και C για 75 ημέρες, αλλοπουρινόλη για 30 ημέρες και Ν-ακετυλοκυστεΐνη (ΝΑC) για 3 ημέρες. Αίμα συλλεγόταν κατά την ηρεμία πριν τη συνεδρία (Rest), αμέσως μετά το τέλος της κάθε συνεδρίας (Εnd) και 120 λεπτά μετά το τέλος της κάθε συνεδρίας (120min into recovery). Οι υποπληθυσμοί των λεμφοκυττάρων μετρήθηκαν με κυτταρομετρία ροής. Πριν τη χορήγηση αντιοξειδωτικών τόσο στο τέλος της ολοσωματικής άσκησης όσο και στο τέλος της αναπνοής μέσα από αντιστάσεις το ποσοστό των κυττάρων φυσικών φονέων (ΝΚ -Natural Killer) αυξήθηκε, το ποσοστό των Τ-βοηθητικών (Th: T-helper) λεμφοκυττάρων και ο λόγος CD4/CD8 ελαττώθηκε (Σύμπλεγμα Διαφοροποίησης ή CD: Cluster of Differentiation). Η χορήγηση αντιοξειδωτικών εξάλειψε τις ανωτέρω μεταβολές μετά τη συνεδρία IRB αλλά όχι και μετά τη συνεδρία WBE. Επιπλέον με το πέρας του IRB τα αντιοξειδωτικά προήγαγαν την αύξηση του ποσοστού των CD8+CD38+ λεμφοκυττάρων και άμβλυναν την αύξηση του ποσοστού των κυτταροτοξικών Τ-λεμφοκυττάρων. Οι μεταβολές του ποσοστού των CD8+CD45RA+ λεμφοκυττάρων αμβλύνθηκαν από τη χορήγηση αντιοξειδωτικών τόσο μετά τη συνεδρία IRB όσο και μετά τη συνεδρία WBE.Συμπερασματικά η αναπνοή μέσα από αντιστάσεις προκαλεί παρόμοιες με την ολοσωματική άσκηση μεταβολές στα ποσοστά των υποπληθυσμών των λεμφοκυττάρων του περιφερικού αίματος. Το οξειδωτικό στρες επηρεάζει κυρίως τις μεταβολές που επάγονται από την αναπνοή μέσα από αντιστάσεις