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

H αποκατάσταση βελτιώνει την φυσική κατάσταση, τα συμπτώματα και την ψυχική υγεία των ασθενών μετά από νοσηλεία για σοβαρή πνευμονία COVID-19

Τα πιθανά πρόσθετα οφέλη της αποκατάστασης πέρα από την φυσική ανάρρωση μετά τον COVID-19 παραμένουν επί του παρόντος άγνωστα. Σε αυτήν την προοπτική, παρεμβατική, μη τυχαιοποιημένη με παράλληλη ανάθεση μελέτη δύο σκελών, διερευνήσαμε τα αποτελέσματα ενός προγράμματος αποκατάστασης 8 εβδομάδων (Rehab: ομάδα αποκατάστασης, αριθμός ατόμων (η)=25) που προστέθηκε στη συνήθη φροντίδα (Usual Care-UC) έναντι της συνήθους φροντίδας (n=27). Η μελέτη αφορούσε στα συμπτώματα από το αναπνευστικό σύστημα, την κόπωση, την λειτουργική ικανότητα, την ψυχική υγεία και την σχετιζόμενη με την υγεία ποιότητα ζωής (HRQoL) σε ασθενείς με πνευμονία COVID-19, 6-8 εβδομάδες μετά το εξιτήριο από το νοσοκομείο. Το πρόγραμμα αποκατάστασης περιλάμβανε άσκηση, εκπαίδευση, διατροφολογική και ψυχολογική υποστήριξη. Οι ασθενείς με ΧΑΠ, αναπνευστική και καρδιακή ανεπάρκεια αποκλείστηκαν από την μελέτη. Οι ομάδες κατά την έναρξη δεν διέφεραν ως προς τη μέση ηλικία (56 έτη), το φύλο (53% γυναίκες), την εισαγωγή στη ΜΕΘ (61%), την διασωλήνωση (39%), τις ημέρες νοσηλείας (25), τον αριθμό των συμπτωμάτων (9) και τον αριθμό των συννοσηροτήτων (1.4). Η βασική αξιολόγηση διεξήχθη στη διάμεση τιμή (Διατεταρτημοριακό εύρος Interquartile Range-IQR) των 76 (27) ημερών μετά την έναρξη των συμπτωμάτων. Οι ομάδες δεν ήταν διαφορετικές όσον αφορά τα αποτελέσματα της βασικής αξιολόγησης. Στις 8 εβδομάδων η Rehab έδειξε σημαντικά μεγαλύτερη βελτίωση στο τεστ Αξιολόγησης ΧΑΠ (CAT-COPD Assessment Test) κατά μέσο όρο ± τυπικό σφάλμα του μέσου όρου (95% διάστημα εμπιστοσύνης) mean±SEM (95%CI) 7,07±1,36 (4,29-9,84), p<0,001; και τα τρία ερωτηματολόγια κόπωσης: Chalder-βαθμολόγηση likert: 5,65±1,27 (3,04-8,25), p<0,001, διτροπική βαθμολόγηση: 3,04±0,86 (1,28-4,79), p=0,001, Functional Assessment of Chronic Illness Therapy (FACIT): 6,37±2,09 (2,08-10,65), p=0,005 και Fatigue Severity Scale (FSS): 1,36±0,433 (0,47-2,25), p=0,004. Επιπλέον σημαντικά μεγαλύτερη βελτίωση παρατηρήθηκε για την ομάδα Rehab στην βαθμολογία φυσικής κατάστασης Short Physical Performance Battery (SPPB): 1,13±0,33 (0,46-1,79), p=0,002, την σχετιζόμενη με τη νοσηλεία κλίμακα άγχους και κατάθλιψης (HADS) σκέλος άγχος: 2,93±1,01 (0,67-5,18), p=0,013, την κλίμακα κατάθλιψης Beck: 7,81±3,07 (1,52-14,09), p=0,017, την γνωστική αξιολόγηση Μόντρεαλ: 2,83±0,63 (1,5-4,14), p<0,001 και το ερωτηματολόγιο HRQoL EQ-5D-5L τόσο στη βαθμολόγηση Utility Index: 0,21±0,05 (0,1-0,32), p=0,001 όσο και στην οπτική αναλογική κλίμακα (Visual Analog Scale): 6,57±3,21 (0,2-13,16), p=0,046. Και οι δύο ομάδες βελτίωσαν σημαντικά την δοκιμασία βάδισης 6 λεπτών κατά περίπου 60 μέτρα και τις μετρήσεις της πνευμονικής λειτουργίας, ενώ η μέτρηση της διαταραχής μετατραυματικού στρες (IES-R) και η βαθμολογία HADS-σκέλος κατάθλιψη δεν διέφεραν μεταξύ των ομάδων στις 8 εβδομάδες. Ένα ποσοστό 16% αποχώρησης από το πρόγραμμα παρατηρήθηκε στην ομάδα αποκατάστασης που εμφάνισε τριπλάσια αύξηση της έντασης της άσκησης. Δεν αναφέρθηκαν ανεπιθύμητες ενέργειες κατά τη διάρκεια της αποκατάστασης. Τα ανωτέρω ευρήματα υπογραμμίζουν την προστιθέμενη αξία της αποκατάστασης μετά τον COVID-19 ως προς την ενίσχυση της φυσικής ανάρρωσης τόσο ως προς την ικανότητα για άσκηση και την φυσική κατάσταση όσο και στην ψυχική υγεία και την γνωστική λειτουργία.The potential additive benefits of rehabilitation beyond spontaneous recovery post COVID-19 currently remain unknown. In this prospective, interventional, non-randomised parallel assignment two-arm study, we investigated the effects of an 8-week rehabilitation programme (Rehab, n=25) added to usual care (UC) versus UC (n=27) on respiratory symptoms, fatigue, functional capacity, mental health, and health-related quality of life in patients with COVID-19 pneumonia, 6-8 weeks post-hospital discharge. The rehabilitation programme included exercise, education, dietary and psychological support. COPD, respiratory and heart failure patients were excluded from the study. At baseline groups were not different in mean age (56 years), gender (53% female), ICU admission (61%), intubation (39%), days of hospitalisation (25), number of symptoms (9), and number of comorbidities (1.4). Baseline evaluation was conducted at median (Interquartile Range-IQR) 76 (27) days after symptoms onset. Groups were not different regarding baseline evaluation outcomes. At 8-weeks Rehab showed significantly greater improvement in COPD Assessment Test by a mean±SEM (95%CI) 7.07±1.36 (4.29-9.84), p<0.001; all three fatigue questionnaires: Chalder-likert: 5.65±1.27 (3.04-8.25), p<0.001; bimodal: 3.04±0.86 (1.28-4.79), p=0.001; FACIT: 6.37±2.09 (2.08-10.65), p=0.005 and FSS: 1.36±0.433 (0.47-2.25), p=0.004; Short Physical Performance Battery: 1.13±0.33 (0.46-1.79), p=0.002; HADS anxiety: 2.93±1.01 (0.67-5.18), p=0.013; Beck Depression Inventory: 7.81±3.07 (1.52-14.09), p=0.017; Montreal Cognitive Assessment: 2.83±0.63 (1.5-4.14), p<0.001; EQ-5D-5L Utility Index: 0.21±0,05 (0.1-0.32), p=0.001 and Visual Analog Scale: 6.57±3.21 (0.2-13.16), p=0.046. Both groups significantly improved 6-min walking distance by approximately 60 meters and pulmonary function measures, whereas Post Traumatic Stress disorder measurement (IES-R) and HADS-Depression score were not different between groups at 8-weeks. A 16% attrition rate was observed in the rehabilitation group exhibiting a 3-fold increase in training workload. There were no adverse effects reported during exercise training. These findings highlight the added value of rehabilitation post COVID-19 to amplify the natural course of physical and mental recovery that otherwise would remain incomplete with UC

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

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

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

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