Stelios Assimakopoulos - Academia.edu (original) (raw)

Papers by Stelios Assimakopoulos

The novel severe acute respiratory coronavirus-2 (SARS-Cov-2) constitutes the causative agent of ... more The novel severe acute respiratory coronavirus-2 (SARS-Cov-2) constitutes the causative agent of coronavirus disease-2019 (COVID-19). Several mechanisms have been proposed regarding the development of cardiovascular complications during and after acute COVID-19 infection. COVID-19, caused by SARS-CoV-2, has emerged as one of the deadliest pandemics in modern history. Several clinical and pathophysiologic mechanisms have been proposed for development of cardiovascular complications during and after acute COVID-19 infection. The myocardial injury in patients with COVID-19 has been attributed to coronary spasm, microthrombi formation, plaque rupture, hypoxic injury or cytokine storm disposing the same pathophysiology with the three clinical variants of Kounis syndrome. One of the main proposed mechanisms for development of cardiovascular complications is the angiotensin converting enzyme 2 (ACE2) and its interactions with the renin-aldosterone system (RAAS) and the kinin-kallikrein sys...

World Journal of Gastroenterology, 2009

Although favourable results of pentoxifylline (PTX) used in treatment of severe alcoholic hepatit... more Although favourable results of pentoxifylline (PTX) used in treatment of severe alcoholic hepatitis patients with a Maddrey discriminant function score ≥ 32 have been previously reported, it is not currently recommended as a first line treatment for alcoholic hepatitis owing to lack of evidence for its efficacy as compared to the standard treatment with corticosteroids. In a very recent issue

World Journal of Gastroenterology, 2008

B o m b e s i n a n d n e u ro t e n s i n a re n e u ro p e p t i d e s which exert a wide spect... more B o m b e s i n a n d n e u ro t e n s i n a re n e u ro p e p t i d e s which exert a wide spectrum of biological actions on gastrointestinal tissues influencing intestinal growth and adaptation, intestinal motility, blood flow, secretion, nutrient absorption and immune response. B ased mainly on their well-established potent enterotrophic effect, numerous experimental studies investigated their potential positive effect on the atrophic or injured intestinal mucosa. These peptides proved to be effective mucosa-healing factors, but the potential molecular and cellular mechanisms for this action remained unresolved. In a recently published study (World J Gastroenterol 2008; 14(8): 1222-1230), it was shown that their protective effect on the intestine in experimentally induced inflammatory bowel disease was related to anti-inflammatory, antioxidant and antiapoptotic actions. These results are in close agreement with our previous studies on jaundiced and hepatectomized rats that showed a regulatory effect of bombesin and neurotensin on critical cellular processes such as enterocyte' proliferation and death, oxidative stress and redox equilibrium, tight junctions' formation and function, and inflammatory response. The pleiotropic effects of bombesin and neurotensin on diverse types of intestinal injury may justify their consideration for clinical trials.

Digestive Diseases and Sciences, May 15, 2019

Acta Gastro-enterologica Belgica, Apr 1, 2007

Diagnosis and treatment of pancreatic and biliary diseases represents a special problem in old pa... more Diagnosis and treatment of pancreatic and biliary diseases represents a special problem in old patients who often suffer from one or more concomitant diseases. The aim of this study was to evaluate the safety and efficacy of ERCP in very old patients (octogenarians). Patients 80 years or older who underwent ERCP from October 2001 to December 2005 were studied retrospectively. A total of 209 patients (121 women, 88 men), with a mean age 86 +/- 4.4 years old (80-102) underwent 251 ERCPs. All but three patients tolerated the procedure well. Three procedures were not completed due to patients' discomfort (1.4%). Two of these patients underwent percutaneous transhepatic cholangiography and the other one was treated conservatively. A cholangiogram was obtained in 193 cases (92.3%), although in 7 patients an additional attempt was required. The main endoscopic findings were common bile duct stones in 51.8% (100/193) and cancer in 28% (54/193) of patients. Based on the diagnostic findings, a therapeutic intervention was indicated in 189 patients (90.4%) and was achieved in 181 of them (95.8%). Complications were observed in 9.6% of ERCPs (24/251). Post - ERCP mild pancreatitis was the more frequent complication in 11 procedures (4.4%). No severe pancreatitis was observed. Six procedures were complicated by cholangitis (2.4%) and two by cholecystitis (0.8%). Early surgical intervention was required in 2 cases because of oesophageal perforation and retroperitoneal perforation respectively. Two patients died (0.8%); one patient with pancreatic cancer died due to septic shock after inadequate biliary drainage and the other one died after operation for retroperitoneal perforation. In conclusion, ERCP is safe and effective method for diagnosis and treatment of biliary and pancreatic disorders in octogenarians despite the high comorbidity in this group of patients.

Annals of Gastroenterology, 2020

Background No evidence is available on the natural history of grade 1 ascites and its progression... more Background No evidence is available on the natural history of grade 1 ascites and its progression to grade 2/3 in patients with liver cirrhosis. The aim of the current study was to address this issue, to assess the development of main comorbid disorders closely related to ascites progression, and to identify the predictive factors for survival in this setting. Methods Consecutive Caucasian cirrhotic patients with grade 1 ascites were retrospectively analyzed. None of patients was under treatment with diuretics at diagnosis. Control groups consisted of 145 cirrhotics with grade 2/3 ascites and 175 cirrhotics without ascites. Results Diuretics were initiated in 58 patients with grade 1 ascites at baseline by the attending physician. At the last follow up, 29 patients had no ascites, 33 patients had grade 1 and 38 patients had grade 2/3 ascites. No variable was found to be an independent predictor of grade 2/3 ascites. Seven patients developed spontaneous bacterial peritonitis while under treatment with diuretics; at that time only 1 patient had grade 1 ascites. The mortality rate was similar among all examined groups. Conclusions This study suggests that the presence of grade 1 ascites does not constitute a precursor of grade 2/3 ascites in patients with cirrhosis. Thus, patients with grade 1 ascites do not require specific treatment with diuretics.

Encyclopedia

Infection with SARS-CoV-2 and the resulting COVID-19 can cause both lung and kidney damage. SARS-... more Infection with SARS-CoV-2 and the resulting COVID-19 can cause both lung and kidney damage. SARS-CoV-2 can directly infect renal cells expressing ACE2 receptors, resulting in kidney damage, and acute kidney injury (AKI) has been reported in COVID-19 hospitalized patients. The pathophysiology of COVID-19-associated AKI is multifactorial. Local and systemic inflammation, immune system dysregulation, blood coagulation disorders, and activation of the renin-angiotensin-aldosterone system (RAAS) are factors that contribute to the development of AKI in COVID 19 disease. COVID-19 patients with kidney involvement have a poor prognosis, and patients with chronic kidney disease (CKD) infected with SARS-CoV-2 have an increased mortality risk. CKD patients with COVID-19 may develop end-stage renal disease (ESRD) requiring dialysis. In particular, patients infected with SARS-CoV-2 and requiring dialysis, as well as patients who have undergone kidney transplantation, have an increased risk of mor...

Vaccines

COVID-19 is one of the progressive viral pandemics that originated from East Asia. COVID-19 or SA... more COVID-19 is one of the progressive viral pandemics that originated from East Asia. COVID-19 or SARS-CoV-2 has been shown to be associated with a chain of physio-pathological mechanisms that are basically immunological in nature. In addition, chemokines have been proposed as a subgroup of chemotactic cytokines with different activities ranging from leukocyte recruitment to injury sites, irritation, and inflammation to angiostasis and angiogenesis. Therefore, researchers have categorized the chemotactic elements into four classes, including CX3C, CXC, CC, and C, based on the location of the cysteine motifs in their structures. Considering the severe cases of COVID-19, the hyperproduction of particular chemokines occurring in lung tissue as well as pro-inflammatory cytokines significantly worsen the disease prognosis. According to the studies conducted in the field documenting the changing expression of CXC and CC chemokines in COVID-19 cases, the CC and CXC chemokines contribute to th...

Annals of Oncology, 2021

Background: The COVID-19 pandemic, also known as the coronavirus pandemic, has affected either di... more Background: The COVID-19 pandemic, also known as the coronavirus pandemic, has affected either directly or directly all medical fields. It caused a major reduction of elective surgical operations as well as overall admissions to surgical departments because of the widespread hospital fear and anxiety experienced by most patients during the peak of this outbreak. However, colorectal cancer operations were performed in large numbers also during the pandemic. In order to protect patients and health workers, hygiene and public health measures were intensified when the coronavirus pandemic began. The aim of the present study was to evaluate the rate of surgical site infections (SSIs) after the beginning of COVID-19 hygiene measures, which was in March 2020 in Greece. Methods: A total of 173 patients who underwent elective colorectal cancer surgery were enrolled retrospectively. Patients were divided into two groups. Group A included 98 patients undergoing colorectal cancer surgery between January 2019-December 2019 (pre-COVID-19 era), whereas 75 patients (group B) underwent colorectal cancer procedures between April 2020-March 2021 (after the beginning of COVID-19 hygiene measures). Statistical analyses were done using Stata13. The student’s t-test was used to compare results between groups. Results: SSI developed in 35 of the 173 patients (20.2%). According to the results of our study, there was a statistically significant difference between the total numbers of SSIs between the 2 examined periods. 25 (25.5%) wound infections occurred in group A-patients postoperatively, whereas only 10 (13.3%) SSIs were developed in patients undergoing colorectal cancer surgery after the beginning of COVID-19 measures (P=0.048). Conclusions: The current study demonstrates that COVID-19 hygiene and public health measures affect the rate of SSI after elective colorectal cancer surgery. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Clinical Chemistry and Laboratory Medicine (CCLM), 2021

Frontiers in Medicine, 2022

BackgroundBacterial infections are associated with the risk of variceal bleeding through complex ... more BackgroundBacterial infections are associated with the risk of variceal bleeding through complex pathophysiologic pathways.ObjectivesThe primary objective of the present case-control study was to investigate the role of bacterial translocation and intestinal barrier dysfunction in the pathogenesis of variceal bleeding. A secondary objective was to determine independent predictors of key outcomes in variceal bleeding, including bleeding-related mortality.MethodsEighty-four (n = 84) consecutive patients participated in the study, 41 patients with acute variceal bleeding and 43 patients with stable cirrhosis, and were followed up for 6 weeks. Peripheral blood samples were collected at patient admission and before any therapeutic intervention.ResultsChild-Pugh (CP) score (OR: 1.868; p = 0.044), IgM anti-endotoxin antibody levels (OR: 0.954; p = 0.016) and TGF-β levels (OR: 0.377; p = 0.026) were found to be significant predictors of variceal bleeding. Regression analysis revealed that a...

Nephrology Dialysis Transplantation

Background and Aims Patients with chronic kidney disease (CKD) present evidence of systemic infla... more Background and Aims Patients with chronic kidney disease (CKD) present evidence of systemic inflammation without clinical infection. This is partly attributed to intestinal barrier dysfunction resulting in increased gut permeability with microbial and endotoxin translocation. However, the potential mechanism(s) implicated in increased gut permeability remain unclear. In this study, we investigated several parameters of the intestinal barrier in patients with CKD of various stages. Methods Thirty-three patients with CKD were prospectively enrolled. Patients were divided in stage I-IV CKD (group A, n = 17, 9 of them with IgA nephropathy) or end-stage kidney disease (ESKD) (group B, n = 16) and were compared with 11 healthy controls (group C). Duodenal biopsies from all subjects, obtained by endoscopy, were examined histologically for evaluation of the villous length and apoptotic bodies in cryptal epithelium. Intraepithelial CD3+ T-lymphocytes, expression of occludin and claudin-1 in ...

World Journal of Virology

Frontiers in Immunology

Although coronavirus disease 2019 (COVID-19) is primarily associated with mild respiratory sympto... more Although coronavirus disease 2019 (COVID-19) is primarily associated with mild respiratory symptoms, a subset of patients may develop more complicated disease with systemic complications and multiple organ injury. The gastrointestinal tract may be directly infected by SARS-CoV-2 or secondarily affected by viremia and the release of inflammatory mediators that cause viral entry from the respiratory epithelium. Impaired intestinal barrier function in SARS-CoV-2 infection is a key factor leading to excessive microbial and endotoxin translocation, which triggers a strong systemic immune response and leads to the development of viral sepsis syndrome with severe sequelae. Multiple components of the gut immune system are affected, resulting in a diminished or dysfunctional gut immunological barrier. Antiviral peptides, inflammatory mediators, immune cell chemotaxis, and secretory immunoglobulins are important parameters that are negatively affected in SARS-CoV-2 infection. Mucosal CD4+ and...

Pathogens

Acinetobacter baumannii (AB) has evolved over the last decades as a major problem in carbapenem-r... more Acinetobacter baumannii (AB) has evolved over the last decades as a major problem in carbapenem-resistant gram-negative nosocomial infections, associated with high mortality rates especially in the intensive care unit (ICU). Recent reports highlight the increasing prevalence of resistance to colistin, a last resort therapeutic option for carbapenem-resistant AB. We retrospectively evaluated the characteristics, treatment regimens and outcomes of twenty patients with pan-drug resistant (PDR) AB primary bacteremia hospitalized in the ICU of the University General Hospital of Patras, during a two-year period (October 2020–September 2022). The 28-day mortality reached 50%. Between survivors and non-survivors, no differences were found regarding age, gender, and Charlson comorbidity index (CCI). However, non-survivors had higher APACHE II scores and higher prevalence of septic shock and COVID-19 infection. A significantly higher percentage in the survivor group received Fosfomycin as par...

Frontiers in Immunology

Non-alcoholic fatty liver disease (NAFLD) and Hepatitis B virus infection (HBV) constitute common... more Non-alcoholic fatty liver disease (NAFLD) and Hepatitis B virus infection (HBV) constitute common chronic liver diseases with worldwide distribution. NAFLD burden is expected to grow in the coming decade, especially in western countries, considering the increased incidence of diabetes and obesity. Despite the organized HBV vaccinations and use of anti-viral therapies globally, HBV infection remains endemic and challenging public health issue. As both NAFLD and HBV have been associated with the development of progressive fibrosis, cirrhosis and hepatocellular carcinoma (HCC), the co-occurrence of both diseases has gained great research and clinical interest. The causative relationship between NAFLD and HBV infection has not been elucidated so far. Dysregulated fatty acid metabolism and lipotoxicity in NAFLD disease seems to initiate activation of signaling pathways that enhance pro-inflammatory responses and disrupt hepatocyte cell homeostasis, promoting progression of NAFLD disease ...

Microorganisms

A considerable proportion of patients with severe COVID-19 meet Sepsis-3 criteria and share commo... more A considerable proportion of patients with severe COVID-19 meet Sepsis-3 criteria and share common pathophysiological mechanisms of multiorgan injury with bacterial sepsis, in absence of secondary bacterial infections, a process characterized as “viral sepsis”. The intestinal barrier exerts a central role in the pathophysiological sequence of events that lead from SARS-CoV-2 infection to severe systemic complications. Accumulating evidence suggests that SARS-CoV-2 disrupts the integrity of the biological, mechanical and immunological gut barrier. Specifically, microbiota diversity and beneficial bacteria population are reduced, concurrently with overgrowth of pathogenic bacteria (dysbiosis). Enterocytes’ tight junctions (TJs) are disrupted, and the apoptotic death of intestinal epithelial cells is increased leading to increased gut permeability. In addition, mucosal CD4(+) and CD8(+) T cells, Th17 cells, neutrophils, dendritic cells and macrophages are activated, and T-regulatory ce...

Gastroenterology Review

Portal vein thrombosis is a common complication associated with malignancies such as hepatocellul... more Portal vein thrombosis is a common complication associated with malignancies such as hepatocellular carcinoma, with a dismal and negative impact on prognosis. A thorough literature search in Pubmed and Google Scholar, under the terms 'hepatocellular carcinoma AND portal vein thrombosis', regarding the surgical management of portal vein thrombosis was conducted by the authors, and the associated results are presented in this narrative review. Precise classification of portal vein thrombosis and identification of subgroups of patients that will benefit from surgery is of paramount importance. Evolution of novel surgical techniques in liver resection and associated low morbidity and mortality rates in specialized hepatobiliary centres worldwide have been linked with promising results from the adoption of surgical management in these patients, when compared to systemic chemotherapy or arterial chemoembolization management that has traditionally been followed in such cases.

The novel severe acute respiratory coronavirus-2 (SARS-Cov-2) constitutes the causative agent of ... more The novel severe acute respiratory coronavirus-2 (SARS-Cov-2) constitutes the causative agent of coronavirus disease-2019 (COVID-19). Several mechanisms have been proposed regarding the development of cardiovascular complications during and after acute COVID-19 infection. COVID-19, caused by SARS-CoV-2, has emerged as one of the deadliest pandemics in modern history. Several clinical and pathophysiologic mechanisms have been proposed for development of cardiovascular complications during and after acute COVID-19 infection. The myocardial injury in patients with COVID-19 has been attributed to coronary spasm, microthrombi formation, plaque rupture, hypoxic injury or cytokine storm disposing the same pathophysiology with the three clinical variants of Kounis syndrome. One of the main proposed mechanisms for development of cardiovascular complications is the angiotensin converting enzyme 2 (ACE2) and its interactions with the renin-aldosterone system (RAAS) and the kinin-kallikrein sys...

World Journal of Gastroenterology, 2009

Although favourable results of pentoxifylline (PTX) used in treatment of severe alcoholic hepatit... more Although favourable results of pentoxifylline (PTX) used in treatment of severe alcoholic hepatitis patients with a Maddrey discriminant function score ≥ 32 have been previously reported, it is not currently recommended as a first line treatment for alcoholic hepatitis owing to lack of evidence for its efficacy as compared to the standard treatment with corticosteroids. In a very recent issue

World Journal of Gastroenterology, 2008

B o m b e s i n a n d n e u ro t e n s i n a re n e u ro p e p t i d e s which exert a wide spect... more B o m b e s i n a n d n e u ro t e n s i n a re n e u ro p e p t i d e s which exert a wide spectrum of biological actions on gastrointestinal tissues influencing intestinal growth and adaptation, intestinal motility, blood flow, secretion, nutrient absorption and immune response. B ased mainly on their well-established potent enterotrophic effect, numerous experimental studies investigated their potential positive effect on the atrophic or injured intestinal mucosa. These peptides proved to be effective mucosa-healing factors, but the potential molecular and cellular mechanisms for this action remained unresolved. In a recently published study (World J Gastroenterol 2008; 14(8): 1222-1230), it was shown that their protective effect on the intestine in experimentally induced inflammatory bowel disease was related to anti-inflammatory, antioxidant and antiapoptotic actions. These results are in close agreement with our previous studies on jaundiced and hepatectomized rats that showed a regulatory effect of bombesin and neurotensin on critical cellular processes such as enterocyte' proliferation and death, oxidative stress and redox equilibrium, tight junctions' formation and function, and inflammatory response. The pleiotropic effects of bombesin and neurotensin on diverse types of intestinal injury may justify their consideration for clinical trials.

Digestive Diseases and Sciences, May 15, 2019

Acta Gastro-enterologica Belgica, Apr 1, 2007

Diagnosis and treatment of pancreatic and biliary diseases represents a special problem in old pa... more Diagnosis and treatment of pancreatic and biliary diseases represents a special problem in old patients who often suffer from one or more concomitant diseases. The aim of this study was to evaluate the safety and efficacy of ERCP in very old patients (octogenarians). Patients 80 years or older who underwent ERCP from October 2001 to December 2005 were studied retrospectively. A total of 209 patients (121 women, 88 men), with a mean age 86 +/- 4.4 years old (80-102) underwent 251 ERCPs. All but three patients tolerated the procedure well. Three procedures were not completed due to patients' discomfort (1.4%). Two of these patients underwent percutaneous transhepatic cholangiography and the other one was treated conservatively. A cholangiogram was obtained in 193 cases (92.3%), although in 7 patients an additional attempt was required. The main endoscopic findings were common bile duct stones in 51.8% (100/193) and cancer in 28% (54/193) of patients. Based on the diagnostic findings, a therapeutic intervention was indicated in 189 patients (90.4%) and was achieved in 181 of them (95.8%). Complications were observed in 9.6% of ERCPs (24/251). Post - ERCP mild pancreatitis was the more frequent complication in 11 procedures (4.4%). No severe pancreatitis was observed. Six procedures were complicated by cholangitis (2.4%) and two by cholecystitis (0.8%). Early surgical intervention was required in 2 cases because of oesophageal perforation and retroperitoneal perforation respectively. Two patients died (0.8%); one patient with pancreatic cancer died due to septic shock after inadequate biliary drainage and the other one died after operation for retroperitoneal perforation. In conclusion, ERCP is safe and effective method for diagnosis and treatment of biliary and pancreatic disorders in octogenarians despite the high comorbidity in this group of patients.

Annals of Gastroenterology, 2020

Background No evidence is available on the natural history of grade 1 ascites and its progression... more Background No evidence is available on the natural history of grade 1 ascites and its progression to grade 2/3 in patients with liver cirrhosis. The aim of the current study was to address this issue, to assess the development of main comorbid disorders closely related to ascites progression, and to identify the predictive factors for survival in this setting. Methods Consecutive Caucasian cirrhotic patients with grade 1 ascites were retrospectively analyzed. None of patients was under treatment with diuretics at diagnosis. Control groups consisted of 145 cirrhotics with grade 2/3 ascites and 175 cirrhotics without ascites. Results Diuretics were initiated in 58 patients with grade 1 ascites at baseline by the attending physician. At the last follow up, 29 patients had no ascites, 33 patients had grade 1 and 38 patients had grade 2/3 ascites. No variable was found to be an independent predictor of grade 2/3 ascites. Seven patients developed spontaneous bacterial peritonitis while under treatment with diuretics; at that time only 1 patient had grade 1 ascites. The mortality rate was similar among all examined groups. Conclusions This study suggests that the presence of grade 1 ascites does not constitute a precursor of grade 2/3 ascites in patients with cirrhosis. Thus, patients with grade 1 ascites do not require specific treatment with diuretics.

Encyclopedia

Infection with SARS-CoV-2 and the resulting COVID-19 can cause both lung and kidney damage. SARS-... more Infection with SARS-CoV-2 and the resulting COVID-19 can cause both lung and kidney damage. SARS-CoV-2 can directly infect renal cells expressing ACE2 receptors, resulting in kidney damage, and acute kidney injury (AKI) has been reported in COVID-19 hospitalized patients. The pathophysiology of COVID-19-associated AKI is multifactorial. Local and systemic inflammation, immune system dysregulation, blood coagulation disorders, and activation of the renin-angiotensin-aldosterone system (RAAS) are factors that contribute to the development of AKI in COVID 19 disease. COVID-19 patients with kidney involvement have a poor prognosis, and patients with chronic kidney disease (CKD) infected with SARS-CoV-2 have an increased mortality risk. CKD patients with COVID-19 may develop end-stage renal disease (ESRD) requiring dialysis. In particular, patients infected with SARS-CoV-2 and requiring dialysis, as well as patients who have undergone kidney transplantation, have an increased risk of mor...

Vaccines

COVID-19 is one of the progressive viral pandemics that originated from East Asia. COVID-19 or SA... more COVID-19 is one of the progressive viral pandemics that originated from East Asia. COVID-19 or SARS-CoV-2 has been shown to be associated with a chain of physio-pathological mechanisms that are basically immunological in nature. In addition, chemokines have been proposed as a subgroup of chemotactic cytokines with different activities ranging from leukocyte recruitment to injury sites, irritation, and inflammation to angiostasis and angiogenesis. Therefore, researchers have categorized the chemotactic elements into four classes, including CX3C, CXC, CC, and C, based on the location of the cysteine motifs in their structures. Considering the severe cases of COVID-19, the hyperproduction of particular chemokines occurring in lung tissue as well as pro-inflammatory cytokines significantly worsen the disease prognosis. According to the studies conducted in the field documenting the changing expression of CXC and CC chemokines in COVID-19 cases, the CC and CXC chemokines contribute to th...

Annals of Oncology, 2021

Background: The COVID-19 pandemic, also known as the coronavirus pandemic, has affected either di... more Background: The COVID-19 pandemic, also known as the coronavirus pandemic, has affected either directly or directly all medical fields. It caused a major reduction of elective surgical operations as well as overall admissions to surgical departments because of the widespread hospital fear and anxiety experienced by most patients during the peak of this outbreak. However, colorectal cancer operations were performed in large numbers also during the pandemic. In order to protect patients and health workers, hygiene and public health measures were intensified when the coronavirus pandemic began. The aim of the present study was to evaluate the rate of surgical site infections (SSIs) after the beginning of COVID-19 hygiene measures, which was in March 2020 in Greece. Methods: A total of 173 patients who underwent elective colorectal cancer surgery were enrolled retrospectively. Patients were divided into two groups. Group A included 98 patients undergoing colorectal cancer surgery between January 2019-December 2019 (pre-COVID-19 era), whereas 75 patients (group B) underwent colorectal cancer procedures between April 2020-March 2021 (after the beginning of COVID-19 hygiene measures). Statistical analyses were done using Stata13. The student’s t-test was used to compare results between groups. Results: SSI developed in 35 of the 173 patients (20.2%). According to the results of our study, there was a statistically significant difference between the total numbers of SSIs between the 2 examined periods. 25 (25.5%) wound infections occurred in group A-patients postoperatively, whereas only 10 (13.3%) SSIs were developed in patients undergoing colorectal cancer surgery after the beginning of COVID-19 measures (P=0.048). Conclusions: The current study demonstrates that COVID-19 hygiene and public health measures affect the rate of SSI after elective colorectal cancer surgery. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Clinical Chemistry and Laboratory Medicine (CCLM), 2021

Frontiers in Medicine, 2022

BackgroundBacterial infections are associated with the risk of variceal bleeding through complex ... more BackgroundBacterial infections are associated with the risk of variceal bleeding through complex pathophysiologic pathways.ObjectivesThe primary objective of the present case-control study was to investigate the role of bacterial translocation and intestinal barrier dysfunction in the pathogenesis of variceal bleeding. A secondary objective was to determine independent predictors of key outcomes in variceal bleeding, including bleeding-related mortality.MethodsEighty-four (n = 84) consecutive patients participated in the study, 41 patients with acute variceal bleeding and 43 patients with stable cirrhosis, and were followed up for 6 weeks. Peripheral blood samples were collected at patient admission and before any therapeutic intervention.ResultsChild-Pugh (CP) score (OR: 1.868; p = 0.044), IgM anti-endotoxin antibody levels (OR: 0.954; p = 0.016) and TGF-β levels (OR: 0.377; p = 0.026) were found to be significant predictors of variceal bleeding. Regression analysis revealed that a...

Nephrology Dialysis Transplantation

Background and Aims Patients with chronic kidney disease (CKD) present evidence of systemic infla... more Background and Aims Patients with chronic kidney disease (CKD) present evidence of systemic inflammation without clinical infection. This is partly attributed to intestinal barrier dysfunction resulting in increased gut permeability with microbial and endotoxin translocation. However, the potential mechanism(s) implicated in increased gut permeability remain unclear. In this study, we investigated several parameters of the intestinal barrier in patients with CKD of various stages. Methods Thirty-three patients with CKD were prospectively enrolled. Patients were divided in stage I-IV CKD (group A, n = 17, 9 of them with IgA nephropathy) or end-stage kidney disease (ESKD) (group B, n = 16) and were compared with 11 healthy controls (group C). Duodenal biopsies from all subjects, obtained by endoscopy, were examined histologically for evaluation of the villous length and apoptotic bodies in cryptal epithelium. Intraepithelial CD3+ T-lymphocytes, expression of occludin and claudin-1 in ...

World Journal of Virology

Frontiers in Immunology

Although coronavirus disease 2019 (COVID-19) is primarily associated with mild respiratory sympto... more Although coronavirus disease 2019 (COVID-19) is primarily associated with mild respiratory symptoms, a subset of patients may develop more complicated disease with systemic complications and multiple organ injury. The gastrointestinal tract may be directly infected by SARS-CoV-2 or secondarily affected by viremia and the release of inflammatory mediators that cause viral entry from the respiratory epithelium. Impaired intestinal barrier function in SARS-CoV-2 infection is a key factor leading to excessive microbial and endotoxin translocation, which triggers a strong systemic immune response and leads to the development of viral sepsis syndrome with severe sequelae. Multiple components of the gut immune system are affected, resulting in a diminished or dysfunctional gut immunological barrier. Antiviral peptides, inflammatory mediators, immune cell chemotaxis, and secretory immunoglobulins are important parameters that are negatively affected in SARS-CoV-2 infection. Mucosal CD4+ and...

Pathogens

Acinetobacter baumannii (AB) has evolved over the last decades as a major problem in carbapenem-r... more Acinetobacter baumannii (AB) has evolved over the last decades as a major problem in carbapenem-resistant gram-negative nosocomial infections, associated with high mortality rates especially in the intensive care unit (ICU). Recent reports highlight the increasing prevalence of resistance to colistin, a last resort therapeutic option for carbapenem-resistant AB. We retrospectively evaluated the characteristics, treatment regimens and outcomes of twenty patients with pan-drug resistant (PDR) AB primary bacteremia hospitalized in the ICU of the University General Hospital of Patras, during a two-year period (October 2020–September 2022). The 28-day mortality reached 50%. Between survivors and non-survivors, no differences were found regarding age, gender, and Charlson comorbidity index (CCI). However, non-survivors had higher APACHE II scores and higher prevalence of septic shock and COVID-19 infection. A significantly higher percentage in the survivor group received Fosfomycin as par...

Frontiers in Immunology

Non-alcoholic fatty liver disease (NAFLD) and Hepatitis B virus infection (HBV) constitute common... more Non-alcoholic fatty liver disease (NAFLD) and Hepatitis B virus infection (HBV) constitute common chronic liver diseases with worldwide distribution. NAFLD burden is expected to grow in the coming decade, especially in western countries, considering the increased incidence of diabetes and obesity. Despite the organized HBV vaccinations and use of anti-viral therapies globally, HBV infection remains endemic and challenging public health issue. As both NAFLD and HBV have been associated with the development of progressive fibrosis, cirrhosis and hepatocellular carcinoma (HCC), the co-occurrence of both diseases has gained great research and clinical interest. The causative relationship between NAFLD and HBV infection has not been elucidated so far. Dysregulated fatty acid metabolism and lipotoxicity in NAFLD disease seems to initiate activation of signaling pathways that enhance pro-inflammatory responses and disrupt hepatocyte cell homeostasis, promoting progression of NAFLD disease ...

Microorganisms

A considerable proportion of patients with severe COVID-19 meet Sepsis-3 criteria and share commo... more A considerable proportion of patients with severe COVID-19 meet Sepsis-3 criteria and share common pathophysiological mechanisms of multiorgan injury with bacterial sepsis, in absence of secondary bacterial infections, a process characterized as “viral sepsis”. The intestinal barrier exerts a central role in the pathophysiological sequence of events that lead from SARS-CoV-2 infection to severe systemic complications. Accumulating evidence suggests that SARS-CoV-2 disrupts the integrity of the biological, mechanical and immunological gut barrier. Specifically, microbiota diversity and beneficial bacteria population are reduced, concurrently with overgrowth of pathogenic bacteria (dysbiosis). Enterocytes’ tight junctions (TJs) are disrupted, and the apoptotic death of intestinal epithelial cells is increased leading to increased gut permeability. In addition, mucosal CD4(+) and CD8(+) T cells, Th17 cells, neutrophils, dendritic cells and macrophages are activated, and T-regulatory ce...

Gastroenterology Review

Portal vein thrombosis is a common complication associated with malignancies such as hepatocellul... more Portal vein thrombosis is a common complication associated with malignancies such as hepatocellular carcinoma, with a dismal and negative impact on prognosis. A thorough literature search in Pubmed and Google Scholar, under the terms 'hepatocellular carcinoma AND portal vein thrombosis', regarding the surgical management of portal vein thrombosis was conducted by the authors, and the associated results are presented in this narrative review. Precise classification of portal vein thrombosis and identification of subgroups of patients that will benefit from surgery is of paramount importance. Evolution of novel surgical techniques in liver resection and associated low morbidity and mortality rates in specialized hepatobiliary centres worldwide have been linked with promising results from the adoption of surgical management in these patients, when compared to systemic chemotherapy or arterial chemoembolization management that has traditionally been followed in such cases.