12 research outputs found
Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study
: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)
Repurposing current therapeutic regimens against SARS-CoV-2 (Review)
The recent coronavirus outbreak has spread worldwide, with the exception
of Antarctica, causing serious social and economic disruption. All
disciplines of the science community are driven to confront the impact
of the COVID-19 pandemic, as currently, there is neither prophylactic
nor therapeutic treatments available. Due to the urgency of the
situation, various research strategies are ongoing, in order to evaluate
the therapeutic efficacy of repurposed and experimental drugs. The
present review presents the most promising repurposed regimens, which
may be used for the treatment of COVID-19. The drugs/bioactive
substances presented herein belong to diverse therapeutic classes,
including antimalarial, cardioprotective, angiotensin-converting enzyme
2 inhibitors, antiviral, anti-inflammatory and antiparasitic drugs.
Therapeutic perspectives of vaccination and passive immunization are
also reviewed
Interplay between baroreflex sensitivity, obesity and related cardiometabolic risk factors (Review)
The baroreflex represents a rapid negative feedback system implicated in
blood pressure regulation, which aims to prevent blood pressure
variations by regulating peripheral vascular tone and cardiac output.
The aim of the present review was to highlight the association between
baroreflex sensitivity (BRS) and obesity, including factors associated
with obesity, such as metabolic syndrome, hypertension, cardiovascular
disease and diabetes. For the present review, a literature search was
conducted using the PubMed database until August 21, 2021. The searched
terms included `baroreflex', and other terms such as `sensitivity',
`obesity', `metabolic syndrome', `hypertension', `diabetes', `gender',
`aging', `children', `adolescents', `physical activity', `bariatric
surgery', `autonomous nervous system' and `cardiometabolic risk
factors'. Obesity and its related metabolic disorders can influence
baroreflex functionality and decrease BRS, mostly by potentiating
sympathetic nervous system activity. Obesity induces inflammation, which
can increase sympathetic system activity and lead to a higher incidence
of cardiovascular events. Obesity also represents an important risk
factor for hypertension through numerous mechanisms; in this setting,
dysfunctional baroreceptors are not able to protect against constantly
elevated blood pressure. Furthermore, diabetes mellitus and oxidative
stress result in deterioration of BRS, whereas aging is also generally
related to reduced cardiovagal BRS. Differences in BRS have also been
observed between men and women, and overall cardiovagal BRS in healthy
women is less intense compared with that in men. BRS appears lower in
children with obesity compared with that in children of a healthy
weight. Notably, physical exercise can increase BRS in both hypertensive
and normotensive subjects, and BRS can also be significantly improved
following bariatric surgery and weight loss. In conclusion, obesity and
its related metabolic disorders may influence baroreflex functionality
and decrease BRS, and baroreceptors cannot protect against the
constantly elevated blood pressure in obesity. However, following
bariatric surgery and weight loss, BRS can be significantly improved.
The present review summarizes the role of obesity and related metabolic
risk factors in BRS, providing details on possible mechanisms and
shedding light on their interplay leading to autonomic neuropathy
A retrospective study on the evaluation of the symptoms, medications and improvement of the quality of life of patients undergoing robotic surgery for gastroesophageal reflux disease
Gastroesophageal reflux disease (GERD) is a common gastrointestinal
disorder requiring lifestyle adaptations and administration of
medications. Another approach is the surgical treatment of GERD through
laparoscopic or robotic operations. The aim of the present study was to
investigate the improvement of symptoms and quality of life of patients
with GERD, before and after robotic surgical restoration using the
Nissen robotic fundoplication technique. The potential effects of body
weight, age and sex, as well as the response to medications and progress
over time, were also assessed. A retrospective study was conducted in a
tertiary hospital between October 2019 and March 2020. Data were
collected and recorded from 144 patients who underwent robotic surgery,
using the Nissen fundoplication technique, during the period 2009-2019.
All patients involved in this analysis pre-operatively exhibited severe
symptoms of heartburn and reflux, as well as poor quality of life. All
of these symptoms were re-examined after surgery, and a marked decrease
was observed with respect to their frequency and intensity. Improvement
was not affected by body mass index, whereas older patients exhibited
greater improvement. Women initially experienced more severe symptoms
before the surgery, but they appeared to respond as well as the male
patients. The long-term beneficial effects of surgery for up to the
10-year period studied were validated. After the robotic surgical
rehabilitation, the vast majority of patients overcame the unpleasant
symptoms of GERD and stayed off their medications. More than 4/5 of the
patients were satisfied after surgery. In conclusion, restoration of
GERD, using Nissen robotic fundoplication, led to the minimization of
symptoms and to a marked improvement in the quality of life of patients
Detoxification unit of the addictions department at the Psychiatric Hospital of Thessaloniki: a prototype unit in Greece. Admissions data, completion rates and referrals to other programmes, 1996–2004
The Greek Collaborative Long COVID Study: Non-Hospitalized and Hospitalized Patients Share Similar Symptom Patterns
Long COVID-19 syndrome refers to persisting symptoms (>12 weeks) after the initial coronavirus infection and is estimated to affect 3% to 12% of people diagnosed with the disease globally. Aim: We conducted a collaborative study with the Long COVID patient organization in Greece, in order to estimate the characteristics, symptoms, and challenges these patients confront. Methods: Data were collected from 208 patients using unstructured qualitative free-text entries in an anonymized online questionnaire. Results: The majority of respondents (68.8%) were not hospitalized and reported lingering symptoms (66.8%) for more than six months. Eighteen different symptoms (fatigue, palpitations, shortness of breath, parosmia, etc.) were mentioned in both hospitalized and community patients. Awareness of Long COVID sequelae seems to be low even among medical doctors. Treatment options incorporating targeted rehabilitation programs are either not available or still not included inthe management plan of Long COVID patients. Conclusions: Patients infected with coronavirus with initial mild symptoms suffer from the same persistent symptoms as those who were hospitalized. Long COVID syndrome appears to be a multi-systemic entity and a multidisciplinary medical approach should be adopted in order to correctly diagnose and successfully manage these patients