Nikolaos Markou - Academia.edu (original) (raw)

Papers by Nikolaos Markou

Critical Care

Following publication of the original article [1], an error was identified in the article title: ... more Following publication of the original article [1], an error was identified in the article title: COVID-19 was incorrectly captured as COIVD-19. The article title has been updated above and in the original article.

Post Splenectomy Sepsis of Multi Trauma Patients in the ICU Leonidas Grigorakos1,2,*, Ioannis Nik... more Post Splenectomy Sepsis of Multi Trauma Patients in the ICU Leonidas Grigorakos1,2,*, Ioannis Nikolopoulos3, Anastasia Alexopoulou2, Nikolaos Markou4, Nikolaos Skoupas2, Eleftherios Fotiou2, Dimitrios Veldekis3 1Associate Professor of Medicine (ICU), Faculty of Nursing, National and Kapodistrian University of Athens 2Intensive Care at Trauma, Hospital of Athens, KAT, Kifissia, Athens, Greece 3Sotiria’ Regional Chest Diseases Hospital of Athens 4Intensive Care at Latseion Burn Center at Thriasio General Hospital of Eleusis *Corresponding author: Dr. Leonidas Grigorakos, Associate Professor of Medicine (ICU), 36 B Figaleias St, 14564, N. Kifissia, Athens, Greece, Tel: +30.210.3709522; E-mail: grigorakos@parliament.gr; bardani@otenet.gr; alexopoulouanastasia@hotmail.com; nikolaos_markou@hotmail.com; nskoupas@yahoo.com; eleftherios.fotiou@yahoo.gr;dveldekis@yahoo.com Received: 10-09-2015 Accepted: 11-02-2015 Published: 11-18-2015 Copyright: © 2015 Grigorakos et al Research Article

Eucapnic obesity may be associated with an augmented chemosensitivity which represents a compensa... more Eucapnic obesity may be associated with an augmented chemosensitivity which represents a compensatory response to mass loading of the respiratory system. Yet, a small subset of obese subjects who develop daytime hypercapnia demonstrates a blunted respiratory drive. Although secondary to nocturnal hypoventilation and the subsequent development of daytime hypercapnia, this blunted chemosensitivity contributes to the establishment and maintenance of daytime hypercapnia.

SSRN Electronic Journal, 2020

Dysregulation of inflammation is hypothesized to play a crucial role for inducing the severe comp... more Dysregulation of inflammation is hypothesized to play a crucial role for inducing the severe complications of Covid-19, with IL-1/IL-6 pathway being central in these events. Eight patients with severe Covid-19 pneumonia treated with the interleukin-1 receptor antagonist anakinra are reported; seven patients hospitalized in intensive care units (ICUs) in Greece and one non-ICU patient in the Netherlands. Patients scored positive for the hemophagocytosis score and they were diagnosed with secondary hemophagocytic lymphohistocytosis (sHLH). At the end-of-treatment with anakinra, ICU patients had less demands on vasopressors; they also had lower C-reactive protein, procalcitonin, troponin I, D-dimers, and ferritin - the hallmark marker of sHLH. All patients improved their respiratory function. Only two patients died. These data argue that the administration of anakinra may be a viable treatment in severe Covid-19 with sHLH, supporting for larger clinical studies to validate this concept.

Case Reports in Internal Medicine, 2017

This case report describes a case of a patient with Legionnaires’ disease (LD) manifested three d... more This case report describes a case of a patient with Legionnaires’ disease (LD) manifested three days upon his return from a medical conference, which took place in a hotel close to the seaside. Our patient presented to the hospital febrile, weak, confused and with mild difficulty in breathing. After being subjected to several tests, he was diagnosed with LD. Even though his initial urinary antigen test (UAT) was negative, subsequent immunofluorescent assays (IFA) were positive for Legionella pneumophila (LP). The patient was immediately initiated specific antibiotics therapy and supportive measures. After 11 days he was released from the hospital with considerable melioration of his clinical condition and with specific instructions to continue therapy at home.

Studies on head injury-induced pituitary dysfunction are limited in number and conflicting result... more Studies on head injury-induced pituitary dysfunction are limited in number and conflicting results have been reported. To further clarify this issue, 29 consecutive patients (24 males), with severe (n = 21) or moderate (n = 8) head trauma, having a mean age of 37 ± 17 years were investigated in the immediate post-trauma period. All patients required mechanical ventilatory support for 8-55 days and were enrolled in the study within a few days before ICU discharge. Basal hormonal assessment included measurement of cortisol, corticotropin, free thyroxine (fT4), thyrotropin (TSH), testosterone (T) in men, estradiol (E2) in women, prolactin (PRL), and growth hormone (GH). Cortisol and GH levels were measured also after stimulation with 100 µg human corticotropin releasing hormone (hCRH) and 100 µg growth hormone releasing hormone (GHRH), respectively. Cortisol hyporesponsiveness was considered when peak cortisol concentration was less than 20 µg/dl following hCRH. TSH deficiency was diagnosed when a subnormal serum fT4 level was associated with a normal or low TSH. Hypogonadism was considered when T (males) or E2 (women) were below the local reference ranges, in the presence of normal PRL levels. Severe or partial GH deficiencies were defined as a peak GH below 3 µg/l or between 3 and 5 µg/l, respectively, after stimulation with GHRH. Twenty-one subnormal responses were found in 15 of the 29 patients (52%) tested; seven (24%) had hypogonadism, seven (24%) had cortisol hyporesponsiveness, five (17%) had hypothyroidism, and two patients (7%) had partial GH deficiency. These preliminary results suggest that a certain degree of hypopituitarism occurs in more than 50% of patients with moderate or severe head injury in the immediate post-trauma period, with cortisol hyporesponsiveness and hypogonadism being most common. Further studies are required to elucidate the pathogenesis of these abnormalities and to investigate whether they affect long-term morbidity. P2 Cortisol reserve in head trauma victims: evaluation with the low-dose (1 µ µg) corticotropin (ACTH) stimulation test

Studies on head injury-induced pituitary dysfunction are limited in number and conflicting result... more Studies on head injury-induced pituitary dysfunction are limited in number and conflicting results have been reported. To further clarify this issue, 29 consecutive patients (24 males), with severe (n = 21) or moderate (n = 8) head trauma, having a mean age of 37 ± 17 years were investigated in the immediate post-trauma period. All patients required mechanical ventilatory support for 8-55 days and were enrolled in the study within a few days before ICU discharge. Basal hormonal assessment included measurement of cortisol, corticotropin, free thyroxine (fT4), thyrotropin (TSH), testosterone (T) in men, estradiol (E2) in women, prolactin (PRL), and growth hormone (GH). Cortisol and GH levels were measured also after stimulation with 100 µg human corticotropin releasing hormone (hCRH) and 100 µg growth hormone releasing hormone (GHRH), respectively. Cortisol hyporesponsiveness was considered when peak cortisol concentration was less than 20 µg/dl following hCRH. TSH deficiency was diagnosed when a subnormal serum fT4 level was associated with a normal or low TSH. Hypogonadism was considered when T (males) or E2 (women) were below the local reference ranges, in the presence of normal PRL levels. Severe or partial GH deficiencies were defined as a peak GH below 3 µg/l or between 3 and 5 µg/l, respectively, after stimulation with GHRH. Twenty-one subnormal responses were found in 15 of the 29 patients (52%) tested; seven (24%) had hypogonadism, seven (24%) had cortisol hyporesponsiveness, five (17%) had hypothyroidism, and two patients (7%) had partial GH deficiency. These preliminary results suggest that a certain degree of hypopituitarism occurs in more than 50% of patients with moderate or severe head injury in the immediate post-trauma period, with cortisol hyporesponsiveness and hypogonadism being most common. Further studies are required to elucidate the pathogenesis of these abnormalities and to investigate whether they affect long-term morbidity. P2 Cortisol reserve in head trauma victims: evaluation with the low-dose (1 µ µg) corticotropin (ACTH) stimulation test

Purpose: To describe the epidemiology of the acute respiratory distress syndrome (ARDS) in a Braz... more Purpose: To describe the epidemiology of the acute respiratory distress syndrome (ARDS) in a Brazilian ICU. Methods: This prospective observational, non-interventional study, included all consecutive patients with ARDS criteria [1] admitted in the ICU of a Brazilian tertiary hospital, between January 1997 and September 2001. Were collected in a prospective fashion the following variables: age, gender, APACHE II score at ICU admission and at ARDS diagnosis, cause of ARDS, presence of AIDS, cancer and immunosuppression, occurrence of barotrauma, performance of traqueostomy, mortality, duration of mechanical ventilation (MV), length of stay (LOS) in ICU and in hospital. The lung injury score (LIS) [2] was used to quantify the degree of pulmonary injury in the first week of ARDS. Results: There was 2182 patients (P) admitted in ICU during the study period, of whom 141 (6.46%) had ARDS criteria. Seventy-six (54%) were men, the mean age was 46 ± 18 years, APACHE II 18 ± 7 and 19 ± 7 at admission and at ARDS diagnosis, respectively. Septic shock accounted for 42% (60 P) of the ARDS causes, sepsis 22% (31 P), diffuse pulmonary infection 16% (23 P), aspiration pneumonia 11% (15 P), non-septic shock 5% (7 P) and others 4% (5 P). Ten percent (14 P) had AIDS, 30% (43 P) cancer and 25% (36 P) immunosuppression. All patients were mechanically ventilated with Tidal Volume between 4 and 8 ml/kg. Only 3.5% (5 P) had barotrauma and 10% (14 P) performed traqueostomy. Mortality rate was 79% in the ICU. The patients required 12 ± 10 days on MV, ranging from 1 to 55 days. The LOS in ICU and hospital was 14 ± 13 (1-69) days and 28 ± 32 (1-325) days, respectively. There was a time delay of 3.7 ± 4.5 days between admission in ICU and the onset of ARDS. The Murray score (mean ± SD) was 3.2 ± 0.4, 3 ± 0.5, 3 ± 0.5, 2.9 ± 0.6, 2.8 ± 0.7, 2.7 ± 0.7 and 2.6 ± 0.8 in the first 7 days, respectively. Conclusions: ARDS in our hospital has a similar incidence of reports in the USA and Europe. There was a higher mortality, which could be explained by a high incidence of infection causes of ARDS, mainly septic shock, and elevated combined occurrence of AIDS, cancer and immunosuppression, along the degree of LIS. The incidence of barotrauma was low, as a consequence of the current mechanical ventilation strategies.

Purpose: To describe the epidemiology of the acute respiratory distress syndrome (ARDS) in a Braz... more Purpose: To describe the epidemiology of the acute respiratory distress syndrome (ARDS) in a Brazilian ICU. Methods: This prospective observational, non-interventional study, included all consecutive patients with ARDS criteria [1] admitted in the ICU of a Brazilian tertiary hospital, between January 1997 and September 2001. Were collected in a prospective fashion the following variables: age, gender, APACHE II score at ICU admission and at ARDS diagnosis, cause of ARDS, presence of AIDS, cancer and immunosuppression, occurrence of barotrauma, performance of traqueostomy, mortality, duration of mechanical ventilation (MV), length of stay (LOS) in ICU and in hospital. The lung injury score (LIS) [2] was used to quantify the degree of pulmonary injury in the first week of ARDS. Results: There was 2182 patients (P) admitted in ICU during the study period, of whom 141 (6.46%) had ARDS criteria. Seventy-six (54%) were men, the mean age was 46 ± 18 years, APACHE II 18 ± 7 and 19 ± 7 at admission and at ARDS diagnosis, respectively. Septic shock accounted for 42% (60 P) of the ARDS causes, sepsis 22% (31 P), diffuse pulmonary infection 16% (23 P), aspiration pneumonia 11% (15 P), non-septic shock 5% (7 P) and others 4% (5 P). Ten percent (14 P) had AIDS, 30% (43 P) cancer and 25% (36 P) immunosuppression. All patients were mechanically ventilated with Tidal Volume between 4 and 8 ml/kg. Only 3.5% (5 P) had barotrauma and 10% (14 P) performed traqueostomy. Mortality rate was 79% in the ICU. The patients required 12 ± 10 days on MV, ranging from 1 to 55 days. The LOS in ICU and hospital was 14 ± 13 (1-69) days and 28 ± 32 (1-325) days, respectively. There was a time delay of 3.7 ± 4.5 days between admission in ICU and the onset of ARDS. The Murray score (mean ± SD) was 3.2 ± 0.4, 3 ± 0.5, 3 ± 0.5, 2.9 ± 0.6, 2.8 ± 0.7, 2.7 ± 0.7 and 2.6 ± 0.8 in the first 7 days, respectively. Conclusions: ARDS in our hospital has a similar incidence of reports in the USA and Europe. There was a higher mortality, which could be explained by a high incidence of infection causes of ARDS, mainly septic shock, and elevated combined occurrence of AIDS, cancer and immunosuppression, along the degree of LIS. The incidence of barotrauma was low, as a consequence of the current mechanical ventilation strategies.

Respiratory Physiology & Neurobiology, 2003

The purpose of this study was to identify if obesity or obstructive sleep apnea (OSA) influence h... more The purpose of this study was to identify if obesity or obstructive sleep apnea (OSA) influence hypercapnic response (HCR) and hypoxic response (HR) taking into account differences between gender. Data are expressed in % predicted based on reference values of our laboratory ('Respir. Physiol. 113 (1998) 157'). Obese women without OSA (n=117, body mass index (BMI) 43+/-8 kg/m(2)) demonstrated an increased ventilatory (VE) and occlusion pressure (P(0.1)) HCR and HR slope: VE HCR 113 (NS), VE HCR/vital capacity (VC) 126 (P<0.05), P(0.1) HCR 130 (P<0.05), VE HR 136 (P<0.05), VE HR/VC 154 (P<0.001) and P(0.1) HR 210 (P<0.001) % predicted. Obese women with OSA (n=34, BMI 42+/-9 kg/m(2)) presented similar increased values for HCR and even more increased values for HR than obese women without OSA matched for age, height and BMI: VE HR 155 (P=NS), VE HR/VC 205 (P<0.05) and P(0.1) HR 273 (P<0.05) % predicted. In obese men (without or with OSA) HCR and HR values were similar to our reference values.

Additional file 1: Tables S1â S4 and Figures S1â S5.

Applied Sciences, 2022

The aim of this study was to investigate levetiracetam pharmacokinetics in critically ill adult i... more The aim of this study was to investigate levetiracetam pharmacokinetics in critically ill adult intensive care patients and to identify pathophysiological factors affecting its kinetics. Fourteen critically ill patients in an intensive care unit were enrolled in the study and received intravenous levetiracetam. Blood samples were collected at specific time points to determine the levetiracetam pharmacokinetics. Patient characteristics such as renal function, demographics, disease severity, organ dysfunction, and biochemical laboratory tests were evaluated for their influence on the kinetics of levetiracetam. Estimated glomerular filtration rate (eGFR) had a statistically significant (p = 0.001) effect on levetiracetam clearance. None of the other patient characteristics had a statistically significant effect on the pharmacokinetics. Simulations of dosing regimens revealed that even typically administered doses of levetiracetam may result in significantly increased concentrations and...

Mechanical ventilation constitutes one of the therapeutic cornerstones in the treatment of the cr... more Mechanical ventilation constitutes one of the therapeutic cornerstones in the treatment of the critically ill. Depending on the indication for mechanical ventilation, the severity of the patient and the resources available, mechanical ventilation can be applied nowadays at a variety of locations and under different organizational settings. As a rule, the requirements are much more demanding for invasive mechanical ventilation and for the acutely ill patient, especially with increasing patient severity.

at the end of the article Η διάγνωση βρογχικού άσθματος σε αθλητές υψηλών επιδόσεων Εκτός από τη ... more at the end of the article Η διάγνωση βρογχικού άσθματος σε αθλητές υψηλών επιδόσεων Εκτός από τη σπιρομέτρηση* Η άσκηση αποτελεί έναν από τους πλέον συνηθισμένους εκλυτικούς παράγοντες βρογχόσπασμου. Ο βρογχόσπασμος κατά την άσκηση αποτελεί ιδιαίτερα συχνό πρόβλημα σε αθλητές υψηλών επιδόσεων και μπορεί να επηρεάζει σημαντικά τις αθλητικές επιδόσεις. Στα άτομα αυτά, η διάγνωση άσθματος ή βρογχόσπασμου κατά την άσκηση αποτελεί σοβαρή πρόκληση, καθώς η παρουσία συμπτωμάτων έχει χαμηλή ευαισθησία και ειδικότητα, ενώ η σπιρομέτρηση πριν και μετά από βρογχοδιαστολή συνήθως δεν είναι διαγνωστική. Σε πολλές περιπτώσεις, η τεκμηρίωση της διάγνωσης είναι εφικτή μόνο με δοκιμασίες πρόκλησης (άσκηση, εκούσιος ευκαπνικός υπεραερισμός, εισπνοή σκόνης μανιτόλης ή εκνεφώματος υπέρτονου χλωριονατριούχου ορού). Παραμένει ανοικτό το θέμα του συστηματικού ελέγχου όλων των αθλητών υψηλών επιδόσεων για βρογχόσπασμο κατά την άσκηση, ανεξάρτητα από την παρουσία συμπτωμάτων. αθλητές υψηλών επιδόσεων ποικίλ...

Cell Host & Microbe, 2020

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

International Archives of Medicine, Oct 12, 2017

Amniotic Fluid Embolism (AFE) is a rare complication of the intra-and early post-partum period, w... more Amniotic Fluid Embolism (AFE) is a rare complication of the intra-and early post-partum period, which may also be encountered with cesarean delivery and during abortions. Its symptompatology includes respiratory distress with cyanosis, shock and possibly tonic-clonic seizures. Disseminated intravascular coagulation (DIC) frequently occurs and is usually fatal. The aim of this study is to present the positive outcome and our gained experience from two cases suffering from AFE. Thus, we analyze the case of two patients, in the second trimester of pregnancy, who presented symptoms of AFE. Our paper reveals that in the case of patients with AFE, early diagnosis, prompt management and proper treatment increase survival rate and may ensure complete recovery in a relatively short period of time. However, DIC is a serious aggravating factor, which makes the recovery process slower.

Open Journal of Respiratory Diseases, 2017

We report the case of a patient with pulmonary fibrosis, developed as an adverse reaction to nitr... more We report the case of a patient with pulmonary fibrosis, developed as an adverse reaction to nitrofurantoin therapy received for totally 6 months for the prevention of recurrent urinary tract infections. Chest X-ray and CT scan revealed extensive elements of interstitial pulmonary fibrosis. After diagnosis, administration of nitrofurantoin was immediately stopped; and specific prolonged therapy with low-dose corticosteroids per os and inhaled steroids were administered. The patient responded successfully both clinically and biochemically and possible digestive system side effects were prevented through the administration of gastroprotection medication. For the prevention of urinary tract infection, the patient received well tolerated therapy with fosfomycin which was further continued as a prophylactic agent.

Journal of Medical Case Reports, 2016

Background: The aim of this case report is to present our experience with two very rare cases of ... more Background: The aim of this case report is to present our experience with two very rare cases of thoracic muscle tuberculosis. Muscle tuberculosis, as a primary disease, can only be detected in cases in which mycobacteria have been transplanted to a muscle through an infected needle. Case presentations: Case 1 is a 38-year-old immigrant man and Case 2 is a 24-year-old immigrant man, both originating from Sub-Saharan African Countries; they presented in the past two years to our hospital with swellings at the base of the hemithorax and were diagnosed as having muscle tuberculosis. Administration of antituberculosis chemotherapy caused: (a) diminution of inflammation, (b) diminution of the size of local fusiform injury, and (c) clinical improvement. Conclusions: Thoracic muscle tuberculosis should be considered to be one of the etiologies of muscular disease in European countries with a high incidence of immigrants originating from endemic geographical areas.

Critical Care

Following publication of the original article [1], an error was identified in the article title: ... more Following publication of the original article [1], an error was identified in the article title: COVID-19 was incorrectly captured as COIVD-19. The article title has been updated above and in the original article.

Post Splenectomy Sepsis of Multi Trauma Patients in the ICU Leonidas Grigorakos1,2,*, Ioannis Nik... more Post Splenectomy Sepsis of Multi Trauma Patients in the ICU Leonidas Grigorakos1,2,*, Ioannis Nikolopoulos3, Anastasia Alexopoulou2, Nikolaos Markou4, Nikolaos Skoupas2, Eleftherios Fotiou2, Dimitrios Veldekis3 1Associate Professor of Medicine (ICU), Faculty of Nursing, National and Kapodistrian University of Athens 2Intensive Care at Trauma, Hospital of Athens, KAT, Kifissia, Athens, Greece 3Sotiria’ Regional Chest Diseases Hospital of Athens 4Intensive Care at Latseion Burn Center at Thriasio General Hospital of Eleusis *Corresponding author: Dr. Leonidas Grigorakos, Associate Professor of Medicine (ICU), 36 B Figaleias St, 14564, N. Kifissia, Athens, Greece, Tel: +30.210.3709522; E-mail: grigorakos@parliament.gr; bardani@otenet.gr; alexopoulouanastasia@hotmail.com; nikolaos_markou@hotmail.com; nskoupas@yahoo.com; eleftherios.fotiou@yahoo.gr;dveldekis@yahoo.com Received: 10-09-2015 Accepted: 11-02-2015 Published: 11-18-2015 Copyright: © 2015 Grigorakos et al Research Article

Eucapnic obesity may be associated with an augmented chemosensitivity which represents a compensa... more Eucapnic obesity may be associated with an augmented chemosensitivity which represents a compensatory response to mass loading of the respiratory system. Yet, a small subset of obese subjects who develop daytime hypercapnia demonstrates a blunted respiratory drive. Although secondary to nocturnal hypoventilation and the subsequent development of daytime hypercapnia, this blunted chemosensitivity contributes to the establishment and maintenance of daytime hypercapnia.

SSRN Electronic Journal, 2020

Dysregulation of inflammation is hypothesized to play a crucial role for inducing the severe comp... more Dysregulation of inflammation is hypothesized to play a crucial role for inducing the severe complications of Covid-19, with IL-1/IL-6 pathway being central in these events. Eight patients with severe Covid-19 pneumonia treated with the interleukin-1 receptor antagonist anakinra are reported; seven patients hospitalized in intensive care units (ICUs) in Greece and one non-ICU patient in the Netherlands. Patients scored positive for the hemophagocytosis score and they were diagnosed with secondary hemophagocytic lymphohistocytosis (sHLH). At the end-of-treatment with anakinra, ICU patients had less demands on vasopressors; they also had lower C-reactive protein, procalcitonin, troponin I, D-dimers, and ferritin - the hallmark marker of sHLH. All patients improved their respiratory function. Only two patients died. These data argue that the administration of anakinra may be a viable treatment in severe Covid-19 with sHLH, supporting for larger clinical studies to validate this concept.

Case Reports in Internal Medicine, 2017

This case report describes a case of a patient with Legionnaires’ disease (LD) manifested three d... more This case report describes a case of a patient with Legionnaires’ disease (LD) manifested three days upon his return from a medical conference, which took place in a hotel close to the seaside. Our patient presented to the hospital febrile, weak, confused and with mild difficulty in breathing. After being subjected to several tests, he was diagnosed with LD. Even though his initial urinary antigen test (UAT) was negative, subsequent immunofluorescent assays (IFA) were positive for Legionella pneumophila (LP). The patient was immediately initiated specific antibiotics therapy and supportive measures. After 11 days he was released from the hospital with considerable melioration of his clinical condition and with specific instructions to continue therapy at home.

Studies on head injury-induced pituitary dysfunction are limited in number and conflicting result... more Studies on head injury-induced pituitary dysfunction are limited in number and conflicting results have been reported. To further clarify this issue, 29 consecutive patients (24 males), with severe (n = 21) or moderate (n = 8) head trauma, having a mean age of 37 ± 17 years were investigated in the immediate post-trauma period. All patients required mechanical ventilatory support for 8-55 days and were enrolled in the study within a few days before ICU discharge. Basal hormonal assessment included measurement of cortisol, corticotropin, free thyroxine (fT4), thyrotropin (TSH), testosterone (T) in men, estradiol (E2) in women, prolactin (PRL), and growth hormone (GH). Cortisol and GH levels were measured also after stimulation with 100 µg human corticotropin releasing hormone (hCRH) and 100 µg growth hormone releasing hormone (GHRH), respectively. Cortisol hyporesponsiveness was considered when peak cortisol concentration was less than 20 µg/dl following hCRH. TSH deficiency was diagnosed when a subnormal serum fT4 level was associated with a normal or low TSH. Hypogonadism was considered when T (males) or E2 (women) were below the local reference ranges, in the presence of normal PRL levels. Severe or partial GH deficiencies were defined as a peak GH below 3 µg/l or between 3 and 5 µg/l, respectively, after stimulation with GHRH. Twenty-one subnormal responses were found in 15 of the 29 patients (52%) tested; seven (24%) had hypogonadism, seven (24%) had cortisol hyporesponsiveness, five (17%) had hypothyroidism, and two patients (7%) had partial GH deficiency. These preliminary results suggest that a certain degree of hypopituitarism occurs in more than 50% of patients with moderate or severe head injury in the immediate post-trauma period, with cortisol hyporesponsiveness and hypogonadism being most common. Further studies are required to elucidate the pathogenesis of these abnormalities and to investigate whether they affect long-term morbidity. P2 Cortisol reserve in head trauma victims: evaluation with the low-dose (1 µ µg) corticotropin (ACTH) stimulation test

Studies on head injury-induced pituitary dysfunction are limited in number and conflicting result... more Studies on head injury-induced pituitary dysfunction are limited in number and conflicting results have been reported. To further clarify this issue, 29 consecutive patients (24 males), with severe (n = 21) or moderate (n = 8) head trauma, having a mean age of 37 ± 17 years were investigated in the immediate post-trauma period. All patients required mechanical ventilatory support for 8-55 days and were enrolled in the study within a few days before ICU discharge. Basal hormonal assessment included measurement of cortisol, corticotropin, free thyroxine (fT4), thyrotropin (TSH), testosterone (T) in men, estradiol (E2) in women, prolactin (PRL), and growth hormone (GH). Cortisol and GH levels were measured also after stimulation with 100 µg human corticotropin releasing hormone (hCRH) and 100 µg growth hormone releasing hormone (GHRH), respectively. Cortisol hyporesponsiveness was considered when peak cortisol concentration was less than 20 µg/dl following hCRH. TSH deficiency was diagnosed when a subnormal serum fT4 level was associated with a normal or low TSH. Hypogonadism was considered when T (males) or E2 (women) were below the local reference ranges, in the presence of normal PRL levels. Severe or partial GH deficiencies were defined as a peak GH below 3 µg/l or between 3 and 5 µg/l, respectively, after stimulation with GHRH. Twenty-one subnormal responses were found in 15 of the 29 patients (52%) tested; seven (24%) had hypogonadism, seven (24%) had cortisol hyporesponsiveness, five (17%) had hypothyroidism, and two patients (7%) had partial GH deficiency. These preliminary results suggest that a certain degree of hypopituitarism occurs in more than 50% of patients with moderate or severe head injury in the immediate post-trauma period, with cortisol hyporesponsiveness and hypogonadism being most common. Further studies are required to elucidate the pathogenesis of these abnormalities and to investigate whether they affect long-term morbidity. P2 Cortisol reserve in head trauma victims: evaluation with the low-dose (1 µ µg) corticotropin (ACTH) stimulation test

Purpose: To describe the epidemiology of the acute respiratory distress syndrome (ARDS) in a Braz... more Purpose: To describe the epidemiology of the acute respiratory distress syndrome (ARDS) in a Brazilian ICU. Methods: This prospective observational, non-interventional study, included all consecutive patients with ARDS criteria [1] admitted in the ICU of a Brazilian tertiary hospital, between January 1997 and September 2001. Were collected in a prospective fashion the following variables: age, gender, APACHE II score at ICU admission and at ARDS diagnosis, cause of ARDS, presence of AIDS, cancer and immunosuppression, occurrence of barotrauma, performance of traqueostomy, mortality, duration of mechanical ventilation (MV), length of stay (LOS) in ICU and in hospital. The lung injury score (LIS) [2] was used to quantify the degree of pulmonary injury in the first week of ARDS. Results: There was 2182 patients (P) admitted in ICU during the study period, of whom 141 (6.46%) had ARDS criteria. Seventy-six (54%) were men, the mean age was 46 ± 18 years, APACHE II 18 ± 7 and 19 ± 7 at admission and at ARDS diagnosis, respectively. Septic shock accounted for 42% (60 P) of the ARDS causes, sepsis 22% (31 P), diffuse pulmonary infection 16% (23 P), aspiration pneumonia 11% (15 P), non-septic shock 5% (7 P) and others 4% (5 P). Ten percent (14 P) had AIDS, 30% (43 P) cancer and 25% (36 P) immunosuppression. All patients were mechanically ventilated with Tidal Volume between 4 and 8 ml/kg. Only 3.5% (5 P) had barotrauma and 10% (14 P) performed traqueostomy. Mortality rate was 79% in the ICU. The patients required 12 ± 10 days on MV, ranging from 1 to 55 days. The LOS in ICU and hospital was 14 ± 13 (1-69) days and 28 ± 32 (1-325) days, respectively. There was a time delay of 3.7 ± 4.5 days between admission in ICU and the onset of ARDS. The Murray score (mean ± SD) was 3.2 ± 0.4, 3 ± 0.5, 3 ± 0.5, 2.9 ± 0.6, 2.8 ± 0.7, 2.7 ± 0.7 and 2.6 ± 0.8 in the first 7 days, respectively. Conclusions: ARDS in our hospital has a similar incidence of reports in the USA and Europe. There was a higher mortality, which could be explained by a high incidence of infection causes of ARDS, mainly septic shock, and elevated combined occurrence of AIDS, cancer and immunosuppression, along the degree of LIS. The incidence of barotrauma was low, as a consequence of the current mechanical ventilation strategies.

Purpose: To describe the epidemiology of the acute respiratory distress syndrome (ARDS) in a Braz... more Purpose: To describe the epidemiology of the acute respiratory distress syndrome (ARDS) in a Brazilian ICU. Methods: This prospective observational, non-interventional study, included all consecutive patients with ARDS criteria [1] admitted in the ICU of a Brazilian tertiary hospital, between January 1997 and September 2001. Were collected in a prospective fashion the following variables: age, gender, APACHE II score at ICU admission and at ARDS diagnosis, cause of ARDS, presence of AIDS, cancer and immunosuppression, occurrence of barotrauma, performance of traqueostomy, mortality, duration of mechanical ventilation (MV), length of stay (LOS) in ICU and in hospital. The lung injury score (LIS) [2] was used to quantify the degree of pulmonary injury in the first week of ARDS. Results: There was 2182 patients (P) admitted in ICU during the study period, of whom 141 (6.46%) had ARDS criteria. Seventy-six (54%) were men, the mean age was 46 ± 18 years, APACHE II 18 ± 7 and 19 ± 7 at admission and at ARDS diagnosis, respectively. Septic shock accounted for 42% (60 P) of the ARDS causes, sepsis 22% (31 P), diffuse pulmonary infection 16% (23 P), aspiration pneumonia 11% (15 P), non-septic shock 5% (7 P) and others 4% (5 P). Ten percent (14 P) had AIDS, 30% (43 P) cancer and 25% (36 P) immunosuppression. All patients were mechanically ventilated with Tidal Volume between 4 and 8 ml/kg. Only 3.5% (5 P) had barotrauma and 10% (14 P) performed traqueostomy. Mortality rate was 79% in the ICU. The patients required 12 ± 10 days on MV, ranging from 1 to 55 days. The LOS in ICU and hospital was 14 ± 13 (1-69) days and 28 ± 32 (1-325) days, respectively. There was a time delay of 3.7 ± 4.5 days between admission in ICU and the onset of ARDS. The Murray score (mean ± SD) was 3.2 ± 0.4, 3 ± 0.5, 3 ± 0.5, 2.9 ± 0.6, 2.8 ± 0.7, 2.7 ± 0.7 and 2.6 ± 0.8 in the first 7 days, respectively. Conclusions: ARDS in our hospital has a similar incidence of reports in the USA and Europe. There was a higher mortality, which could be explained by a high incidence of infection causes of ARDS, mainly septic shock, and elevated combined occurrence of AIDS, cancer and immunosuppression, along the degree of LIS. The incidence of barotrauma was low, as a consequence of the current mechanical ventilation strategies.

Respiratory Physiology & Neurobiology, 2003

The purpose of this study was to identify if obesity or obstructive sleep apnea (OSA) influence h... more The purpose of this study was to identify if obesity or obstructive sleep apnea (OSA) influence hypercapnic response (HCR) and hypoxic response (HR) taking into account differences between gender. Data are expressed in % predicted based on reference values of our laboratory ('Respir. Physiol. 113 (1998) 157'). Obese women without OSA (n=117, body mass index (BMI) 43+/-8 kg/m(2)) demonstrated an increased ventilatory (VE) and occlusion pressure (P(0.1)) HCR and HR slope: VE HCR 113 (NS), VE HCR/vital capacity (VC) 126 (P<0.05), P(0.1) HCR 130 (P<0.05), VE HR 136 (P<0.05), VE HR/VC 154 (P<0.001) and P(0.1) HR 210 (P<0.001) % predicted. Obese women with OSA (n=34, BMI 42+/-9 kg/m(2)) presented similar increased values for HCR and even more increased values for HR than obese women without OSA matched for age, height and BMI: VE HR 155 (P=NS), VE HR/VC 205 (P<0.05) and P(0.1) HR 273 (P<0.05) % predicted. In obese men (without or with OSA) HCR and HR values were similar to our reference values.

Additional file 1: Tables S1â S4 and Figures S1â S5.

Applied Sciences, 2022

The aim of this study was to investigate levetiracetam pharmacokinetics in critically ill adult i... more The aim of this study was to investigate levetiracetam pharmacokinetics in critically ill adult intensive care patients and to identify pathophysiological factors affecting its kinetics. Fourteen critically ill patients in an intensive care unit were enrolled in the study and received intravenous levetiracetam. Blood samples were collected at specific time points to determine the levetiracetam pharmacokinetics. Patient characteristics such as renal function, demographics, disease severity, organ dysfunction, and biochemical laboratory tests were evaluated for their influence on the kinetics of levetiracetam. Estimated glomerular filtration rate (eGFR) had a statistically significant (p = 0.001) effect on levetiracetam clearance. None of the other patient characteristics had a statistically significant effect on the pharmacokinetics. Simulations of dosing regimens revealed that even typically administered doses of levetiracetam may result in significantly increased concentrations and...

Mechanical ventilation constitutes one of the therapeutic cornerstones in the treatment of the cr... more Mechanical ventilation constitutes one of the therapeutic cornerstones in the treatment of the critically ill. Depending on the indication for mechanical ventilation, the severity of the patient and the resources available, mechanical ventilation can be applied nowadays at a variety of locations and under different organizational settings. As a rule, the requirements are much more demanding for invasive mechanical ventilation and for the acutely ill patient, especially with increasing patient severity.

at the end of the article Η διάγνωση βρογχικού άσθματος σε αθλητές υψηλών επιδόσεων Εκτός από τη ... more at the end of the article Η διάγνωση βρογχικού άσθματος σε αθλητές υψηλών επιδόσεων Εκτός από τη σπιρομέτρηση* Η άσκηση αποτελεί έναν από τους πλέον συνηθισμένους εκλυτικούς παράγοντες βρογχόσπασμου. Ο βρογχόσπασμος κατά την άσκηση αποτελεί ιδιαίτερα συχνό πρόβλημα σε αθλητές υψηλών επιδόσεων και μπορεί να επηρεάζει σημαντικά τις αθλητικές επιδόσεις. Στα άτομα αυτά, η διάγνωση άσθματος ή βρογχόσπασμου κατά την άσκηση αποτελεί σοβαρή πρόκληση, καθώς η παρουσία συμπτωμάτων έχει χαμηλή ευαισθησία και ειδικότητα, ενώ η σπιρομέτρηση πριν και μετά από βρογχοδιαστολή συνήθως δεν είναι διαγνωστική. Σε πολλές περιπτώσεις, η τεκμηρίωση της διάγνωσης είναι εφικτή μόνο με δοκιμασίες πρόκλησης (άσκηση, εκούσιος ευκαπνικός υπεραερισμός, εισπνοή σκόνης μανιτόλης ή εκνεφώματος υπέρτονου χλωριονατριούχου ορού). Παραμένει ανοικτό το θέμα του συστηματικού ελέγχου όλων των αθλητών υψηλών επιδόσεων για βρογχόσπασμο κατά την άσκηση, ανεξάρτητα από την παρουσία συμπτωμάτων. αθλητές υψηλών επιδόσεων ποικίλ...

Cell Host & Microbe, 2020

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

International Archives of Medicine, Oct 12, 2017

Amniotic Fluid Embolism (AFE) is a rare complication of the intra-and early post-partum period, w... more Amniotic Fluid Embolism (AFE) is a rare complication of the intra-and early post-partum period, which may also be encountered with cesarean delivery and during abortions. Its symptompatology includes respiratory distress with cyanosis, shock and possibly tonic-clonic seizures. Disseminated intravascular coagulation (DIC) frequently occurs and is usually fatal. The aim of this study is to present the positive outcome and our gained experience from two cases suffering from AFE. Thus, we analyze the case of two patients, in the second trimester of pregnancy, who presented symptoms of AFE. Our paper reveals that in the case of patients with AFE, early diagnosis, prompt management and proper treatment increase survival rate and may ensure complete recovery in a relatively short period of time. However, DIC is a serious aggravating factor, which makes the recovery process slower.

Open Journal of Respiratory Diseases, 2017

We report the case of a patient with pulmonary fibrosis, developed as an adverse reaction to nitr... more We report the case of a patient with pulmonary fibrosis, developed as an adverse reaction to nitrofurantoin therapy received for totally 6 months for the prevention of recurrent urinary tract infections. Chest X-ray and CT scan revealed extensive elements of interstitial pulmonary fibrosis. After diagnosis, administration of nitrofurantoin was immediately stopped; and specific prolonged therapy with low-dose corticosteroids per os and inhaled steroids were administered. The patient responded successfully both clinically and biochemically and possible digestive system side effects were prevented through the administration of gastroprotection medication. For the prevention of urinary tract infection, the patient received well tolerated therapy with fosfomycin which was further continued as a prophylactic agent.

Journal of Medical Case Reports, 2016

Background: The aim of this case report is to present our experience with two very rare cases of ... more Background: The aim of this case report is to present our experience with two very rare cases of thoracic muscle tuberculosis. Muscle tuberculosis, as a primary disease, can only be detected in cases in which mycobacteria have been transplanted to a muscle through an infected needle. Case presentations: Case 1 is a 38-year-old immigrant man and Case 2 is a 24-year-old immigrant man, both originating from Sub-Saharan African Countries; they presented in the past two years to our hospital with swellings at the base of the hemithorax and were diagnosed as having muscle tuberculosis. Administration of antituberculosis chemotherapy caused: (a) diminution of inflammation, (b) diminution of the size of local fusiform injury, and (c) clinical improvement. Conclusions: Thoracic muscle tuberculosis should be considered to be one of the etiologies of muscular disease in European countries with a high incidence of immigrants originating from endemic geographical areas.