72 research outputs found

    Cardiopulmonary Exercise Physiology in AL Amyloidosis Patients with Cardiac Involvement and Its Association with Cardiac Imaging Parameters.

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    Background: Cardiopulmonary exercise testing (CPET) has been widely used for the functional evaluation of patients with heart failure. Patients with amyloidosis and cardiac involvement typically present with heart failure with preserved or mildly reduced ejection fraction. We sought to evaluate the use of CPET parameters in patients with AL amyloidosis for the assessment of disease severity and prognosis and their association with cardiac imaging findings. Methods: A single-center prospective analysis was conducted, which included 23 consecutive ambulatory patients with AL amyloidosis with cardiac involvement, not requiring hospitalization or intravenous diuretics. Patient evaluation included CPET, laboratory testing, echocardiography and cardiac MRI. The cohort was divided according to the presence of high-risk CPET characteristics (below median peak VO2 and above median VE/VCO2). Results: Patients with AL amyloidosis and cardiac involvement (median age was 60 years (56.5% males) had median peak relative VO2 (VO2/kg) of 17.8 mL/kg/min, VE/VCO2 slope of 39.4 and circulatory power of 2362.5 mmHg⋅mL/kg/min. Peak relative VO2 gradually declined across Mayo stages (p = 0.046) and exhibited a significant inverse correlation with NT-proBNP levels (r = −0.52, p = 0.01). Among imaging parameters, peak VO2 positively correlated with global work efficiency (r = 0.61, p < 0.001), and global work index (r = 0.45, p = 0.04). The group of patients with high-risk CPET findings showed evidence of more advanced disease, such as higher NT-proBNP levels (p = 0.007), increased septal and posterior left ventricular wall thickness (p = 0.043 and p = 0.033 respectively) and decreased global work efficiency (p = 0.027) without substantial differences in cardiac MRI parameters. In this group of patients, peak VO2 and VE/VCO2 were not associated significantly with overall survival and cardiac response at one year. Conclusion: In patients with AL amyloidosis, evaluation of exercise capacity with CPET identified a group of patients with more advanced cardiac involvement. The potential of CPET as a risk stratification tool in AL amyloidosis with cardiac involvement warrants further research

    Rethinking stasis and utopianism: empty placards and imaginative boredom in the Greek crisis-scape

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    This chapter traces specific modalities for performing stasis and rethinking utopianism against the backdrop of the recent financial crisis in Greece and, generally, of conditions shaped within the totalizing order Mark Fisher has called “capitalist realism.” Boletsi probes the ways two works deal with the (im)possibility of resistance from within the neoliberal “now”: the short story “Placard and Broomstick” (Ikonomou) and an Athenian wall writing that translates as “I am bored imaginatively.” The empty placard that takes center stage in Ikonomou’s story and the imaginative boredom registered on the walls of Athens test different modalities of stasis against alienation, dispossession, and the contracting of the future. Boletsi argues that both works disengage from conceptions of subjectivity that rest on the binary of either a passive or an active subject—either an acquiescent victim or a revolutionary hero who challenges power from its outside. The story stages the desire for alternative languages by registering a crisis of representation and the inadequacy of existing narratives. The wall writing taps into the modality of the “middle voice” to reconfigure one of the symptoms of capitalist realism—the boredom of unemployment, consumerism, or an indebted life—into a potential resource for different modes of being that carry glimpses of utopianism. Both works, albeit differently, challenge neoliberal imperatives of acquiescence, normalization, or “moving forward.” Although they stage the limited possibilities for resistance within a totalizing system, they also enable alternative configurations of subjectivity, agency, and futurity.Modern and Contemporary Studie

    Introducing infrastructural harm: rethinking moral entanglements, spatio-temporal dynamics, and resistance(s)

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    This introduction provides an initial approach to the conceptual framework of infrastructural harm. It draws upon existing scholarship to discuss infrastructures as relational arrangements co-formative of harm. By approaching infrastructures as sites of ongoing socio-political and environmental antagonism, we pay attention to the ways in which infrastructural harm is generated, accretes, and transmutes across different scales and contexts. We consider harm as a process that exceeds the (in)direct consequences of infrastructure operation to extend to other arrangements. Building upon the diverse case studies discussed in this special issue, we investigate how the political and necropolitical properties of infrastructures are entangled with different technologies, judicial forms, policies, regulations and everyday processes. By foregrounding these diverse manifestations of infrastructural harm, together with its material and immaterial expressions, we expand on the existing literature in order to further explore critical codifications of contemporary socio-technical arrangements

    Comorbidities in coexisting chronic obstructive pulmonary disease and obstructive sleep apnea - Overlap syndrome

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    OBJECTIVE: Chronic Obstructive Pulmonary Disease (COPD) and Obstructive Sleep Apnea (OSA) are separately associated with several comorbidities. The coexistence of the two diseases, referred to as overlap syndrome, may act as a predisposing factor for a higher prevalence of comorbidities compared to those associated with each disease separately. The objective of the study was to evaluate the relative prevalence of cardiovascular as well as other comorbidities, in patients with the overlap syndrome, as compared to patients that are diagnosed solely with OSA. PATIENTS AND METHODS: We examined thirty-eight (38) patients (27 men, 11 women) with coexisting COPD and OSA - overlap syndrome (Group 1) vs. 38 patients with OSA-only (Group 2), matched for sex, age, and Body Mass Index (BMI). All patients underwent pulmonary function tests (PFTs), oximetry and overnight polysomnography and were asked about other coexisting chronic diseases and medications. RESULTS: The two groups differed significantly, as expected, in PFTs (Forced Vital Capacity - FVC, p=0.005, Forced Expiratory Volume in 1 s - FEV1, p&amp;lt;0.001) and in daytime oximetry (p=0.007). Three (3) overlap (7.89%) and 9 OSA patients (23.69%) had no other known diseases. All others suffered from 1 - ≥ 4 comorbidities. Overlap patients suffered more often from multiple (≥ 4) comorbidities than OSA-only patients (11, 28.95% vs. 4, 10.52%, respectively). The most common coexisting diseases were hypertension (50% vs. 42.1%), cardiovascular disease (CVD) (44.74% vs. 26.31%), diabetes mellitus (DM) (28.95% vs. 13.16%), dyslipidemia (21.05% vs. 26.31%) and depression (7.89% vs. 13.16%). CONCLUSIONS: We conclude that comorbidities, especially cardiovascular, in patients with overlap syndrome are at least as prevalent as in sleep apneic only patients and may contribute to the overall severity and prognosis of the disease. © 2018 Verduci Editore s.r.l. All rights reserved

    Sleepiness, fatigue, anxiety and depression in chronic obstructive pulmonary disease and obstructive sleep apnea – overlap – syndrome, before and after continuous positive airways pressure therapy

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    Patients with Chronic Obstructive Pulmonary Disease (COPD) and / or Obstructive Sleep Apnea (OSA) often complain about sleepiness, fatigue, anxiety and depression. However, common screening questionnaires, like Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS) and Hospital Anxiety and Depression Scale (HADS) have not been previous evaluated in patients with overlap–coexisting COPD and OSA–syndrome versus patients with OSA alone. Our study compared ESS, FSS and HADS between patients with overlap syndrome and patients with OSA, before and after treatment with Continuous Positive Airways Pressure (CPAP). We examined 38 patients with coexisting COPD and OSA versus 38 patients with OSA-only and 28 subjects without respiratory disease, serving as controls. All patients underwent pulmonary function tests (PFTs), oximetry and overnight polysomnography and completed the questionnaires, before and after 3 months of CPAP therapy. The two patient groups did not differ significantly in terms of age, Body Mass Index (BMI), neck, waist and hip circumferences, and arterial blood pressure values. They also had similar comorbidities. They differed significantly, as expected, in PFTs (Forced Vital Capacity–FVC, 2.53±0.73 vs 3.08±0.85 lt, p = 0.005, Forced Expiratory Volume in 1sec–FEV1, 1.78± 0.53 vs 2.60±0.73 lt/min, p&lt;0.001) and in daytime oximetry (94.75±2.37 vs 96.13±1.56%, p = 0.007). ESS, HADS–Anxiety and HADS–Depression scores did not differ statistically significant between these two groups, whereas overlap syndrome patients expressed significantly more fatigue (FSS) than OSA-only patients, a finding that persisted even after 3 months of CPAP therapy. We conclude that sleepiness, anxiety and depression were similar in both groups, whereas fatigue was more prominent in patients with overlap syndrome than in sleep apneic patients and did not ameliorate after treatment. © 2018 Economou et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

    Comparison of sleep characteristics during the first and second period of restrictive measures due to COVID-19 pandemic in Greece

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    OBJECTIVE: The first wave of coronavirus pandemic and concomitant restrictive measures affected sleep. We slept more than usual, but the quality was worse. As the pandemic continues, a second period of restrictive measures was initiated, and no data exist about their impact on sleep. The aim of this study was to compare quantity and quality of sleep between the two periods of restrictive measures, due to the Coronavirus Disease-19 (COVID-19) pandemic in Greece. MATERIALS AND METHODS: A web-based survey using a short 13-item questionnaire was created and was distributed online. This included information about demographic and professional data, quantitative and qualitative characteristics of sleep, degree of abidance in lockdown measures, and data about COVID-19 infection or close contact with active confirmed cases. RESULTS: A total of 1,078 questionnaires were evaluated (first period, n=963; second period, n=115). Sleep duration was shorter during the second lockdown (mean difference -0.51h; 95% confidence interval, (CI), -0.82, -0.19, p=0.002). Compared to usual habits, sleep increased in first wave (mean difference +0.37h; 95% CI, 0.26, 0.47; p&lt;0.001) and decreased in second wave (mean difference -0.35h; 95% CI, -0.60, -0.09; p=0.009). Regarding quality of sleep, less participants reported good quality of sleep during the second wave compared to the first (p=0.006). Finally, compliance to restriction measures was lower and the prevalence of confirmed illness or close contact with COVID-19 cases among participants was higher during the second period than during the first one (p&lt;0.001 and p=0.028, respectively). CONCLUSIONS: Our data showed that sleep duration increased during the first lockdown and decreased in the second one, when compared to usual habits. Moreover, sleep quality progressively deteriorated, as the restrictive measures due to coronavirus pandemic continued. © 2022 Verduci Editore s.r.l. All rights reserved
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