Maria (Marianna) Dalamaga | National & Kapodistrian University of Athens (original) (raw)

Papers by Maria (Marianna) Dalamaga

Seminars in Cancer Biology, Jun 1, 2023

Journal of Hypertension, Jun 1, 2015

Hypertensive patients with CKD present an increased risk for cardiovascular mortality. Among the ... more Hypertensive patients with CKD present an increased risk for cardiovascular mortality. Among the proteins synthesized and released from adipose tissue, resistin is a cytokine whose physiologic role has been the subject of much research and controversy. We and others have demonstrated that serum resistin levels are higher in patients with CKD and correlate directly with inflammatory markers, including TNF-α and hsCRP. Since inflammation has been consistently linked to atherosclerosis, death, and cardiovascular (CV) events, our goal was to investigate the interaction between resistin levels and long term all-cause and CV mortality in elderly non-obese and non-diabetic with hypertension. We studied 80 patients (52 men/28 women) 70.9 ± 8.6 years of age with hypertension and CKD. Exclusion criteria was obesity and diabetes mellitus, active infection, acute illness, chronic inflammatory disease or cancer, and immunosuppresive, anti-inflammatory or anti-lipidemic drugs. Demographic data, clinical information and blood samples were collected prospectively. The patients were observed for 5 years. During the follow-up 28 of 80 (35%) patients died: 16 (57%) deaths due to CV events and 12 (43%) of other causes. Patients who died were older and had higher DBP, compared to survivors, but had no differences in BMI, smoking, SBP and HR. Deceased patients had higher WBC, hsCRP, BUN, creatinine, cystatin C, phosphate, magnesium and potassium levels and lower eGFR, Hct/Hg, T3, T4, total cholesterol, LDL-C, albumin and sodium levels compared to survivors. No significant differences in platelet count, TNF-α, fibrinogen, oxLDL, ADMA, HgA1C and HOMA-index were revealed between the groups. eceased patients had significantly higher resistin levels than survivors at baseline (p = 0.025), but adiponectin, visfatin and leptin did not differ between the two groups. Five variables, namely resistin, sodium, cholesterol, T3 and WBC remained significantly associated with survival and were used in the multivariate Cox regression analysis, which revealed that only resisitin, cholesterol and WBC maintained their discriminatory ability, as independent predictors of mortality both by forward and backward stepwise analysis. Elevated serum resistin was a significant independent biomarker of CV and all-cause mortality in elderly, non-diabetic CKD patients with hypertension.

Current obesity reports, Aug 6, 2022

Current Nutrition Reports, Feb 16, 2022

Bariatric surgery has the unique ability to drive substantial and sustainable weight loss in peop... more Bariatric surgery has the unique ability to drive substantial and sustainable weight loss in people living with obesity. Non-reversibility of these surgical techniques provides lifelong benefits but entails the need for continuous medical follow-up. The purpose of the current paper is to review and summarize current data on nutritional deficiencies in patients before and after bariatric surgery. The cornerstone of preventing the emergence of disorders related to nutritional deficiencies is preoperative screening and correct supplementation since they may be exacerbated postoperatively. Following guidelines in conjunction to a lifelong personalized medical approach is of high importance. Bariatric surgery is a well-studied successful and durable means of weight loss that may lead to nutritional deficiencies. There is, thus, a medical need for careful monitoring and treatment of micro- and macronutrient deficiencies by an experienced multidisciplinary team.

Acta dermato-venereologica, Jun 9, 2022

Metabolism open, Dec 1, 2021

The outbreak of COVID-19 was followed by a rapid spread leading to its declaration as a pandemic ... more The outbreak of COVID-19 was followed by a rapid spread leading to its declaration as a pandemic in a short time. The transmission through aerosols and direct contact with infected individuals forced the application of strict safety protocols and rearrangements in the activities of different healthcare systems around the world. Ophthalmology healthcare workers are highly exposed to viral infection and therefore adjustments were made to ensure the safety of patients and health providers by performing only urgent treatments. The suspension and delay in regular follow-up visits and the lower number of patients recorded during the lockdown period due to restrictions and patient anxiety led to severe consequences in the clinical and anatomical outcome affecting the overall prognosis. The current review aims to summarize the effect of the lockdown policies in the number and profile of patients that attended the ophthalmology clinics from different countries and analyze the effect of the pandemic in terms of vision and patient functionality. The effects of the pandemic included a reduction in the number of appointments, cancellations of non-emergency conditions and delays of surgical interventions. These had a negative effect in terms of visual outcomes.

Antioxidants

Obesity involves a chronic state of low-grade inflammation, which is linked to the development of... more Obesity involves a chronic state of low-grade inflammation, which is linked to the development of several comorbidities. Recently, the very low-calorie ketogenic diet (VLCKD) has gained great interest in the treatment of obesity, almost ousting the ancient and healthy Mediterranean diet (MD). However, because these dietary regimens exploit different pathophysiological mechanisms, we hypothesize that adherence to the MD may play a role in determining the efficacy of the VLCKD. We enrolled 318 women (age 38.84 ± 14.37 years; BMI 35.75 ± 5.18 kg/m²) and assessed their anthropometric parameters, body compositions, and adherence to the MD (with the PREvención con DIetaMEDiterránea (PREDIMED) questionnaire) at baseline. The anthropometric parameters and body composition were repeated at the end of the VLCKD. At the end of the VLCKD, the women with high adherence to the MD achieved the best results in terms of weight loss and improved body composition. Specifically, the women who were abov...

Seminars in Cancer Biology

02.01 - Acute critical care

Polskie Archiwum Medycyny Wewnetrznej-polish Archives of Internal Medicine, Nov 25, 2022

Current Nutrition Reports

International Journal of Food Sciences and Nutrition, 2021

Abstract We explored the association between circulating 25OHD and adherence to the Mediterranean... more Abstract We explored the association between circulating 25OHD and adherence to the Mediterranean Diet (MedDiet) in 402 Greek (21–65 years, 188 men and 214 women), normal weight, non-smoker, healthy volunteers in the Athens metropolitan area during summer and autumn, taking into account skin phototype, anthropometric, and lifestyle variables. Circulating 25OHD, parathormone, creatinine, calcium, and phosphate were determined. A vitamin D status of ≤25, ≤50, and ≤75 nmol/L was observed in 4.5, 37.3, and 74.1% of the subjects, respectively. The independent predictors of 25OHD deficiency were autumn, darker skin phototype, BMI, or waist circumference (WC), sunscreen use, less physical outdoor activity, and less adherence to the MedDiet. Higher intake of fish and olive oil was a positive independent predictor of elevated circulating 25OHD levels. In conclusion, higher adherence to the MedDiet, fish and olive oil consumption, were positively associated with circulating 25OHD independently from BMI or WC, skin phototype, season, and physical activity.

Current Obesity Reports, 2021

Purpose of Review Evidence from observational studies suggests that obesity is associated with lo... more Purpose of Review Evidence from observational studies suggests that obesity is associated with low vitamin D. As both obesity and hypovitaminosis D present an alarmingly increased prevalence worldwide, there is an intense research interest to clarify all aspects of this association. This review summarizes current evidence from meta-analyses investigating vitamin D status in obesity, including the effects of weight loss and bariatric surgery on vitamin D status and the outcomes of vitamin D supplementation on body weight. We also discuss potential pathophysiologic mechanisms and important controversies. Recent Findings Data from meta-analyses consistently support an inverse association of vitamin D levels with body weight. However, the impact of weight loss on improving vitamin D status is small, while studies on the supplementation with vitamin D after bariatric surgery have shown conflicting results regarding vitamin D status. Moreover, interventional studies do not support a beneficial effect of vitamin D supplementation on body weight. These findings warrant a cautious interpretation due to important methodological limitations and confounding factors, such as high heterogeneity of studies, variable methods of determination of vitamin D and definition of deficiency/insufficiency, use of various adiposity measures and definitions of obesity, and inadequate adjustment for confounding variables influencing vitamin D levels. The underlying pathogenetic mechanisms associating low vitamin D in obesity include volumetric dilution, sequestration into adipose tissue, limited sunlight exposure, and decreased vitamin D synthesis in the adipose tissue and liver. Experimental studies have demonstrated that low vitamin D may be implicated in adipose tissue differentiation and growth leading to obesity either by regulation of gene expression or through modulation of parathyroid hormone, calcium, and leptin. Summary Obesity is associated with low vitamin D status but weight loss has little effect on improving this; vitamin D supplementation is also not associated with weight loss. Evidence regarding vitamin D status after bariatric surgery is contradicting. The link between vitamin D and obesity remains controversial due to important limitations and confounding of studies. More research is needed to clarify the complex interplay between vitamin D and adiposity.

British Journal of Dermatology, 2021

Brentuximab vedotin (BV) was approved as a therapy for mycosis fungoides (MF) based on the ALCANZ... more Brentuximab vedotin (BV) was approved as a therapy for mycosis fungoides (MF) based on the ALCANZA trial. Little real‐world data, however, are available.

Diabetes & Metabolism, 2021

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

$Research paper thumbnail of Real world evidence: Patients with refractory pemphigus treated with Rituximab$

Metabolism Open, 2021

Background Pemphigus is a group of autoimmune blistering diseases, potentially life-threatening. ... more Background Pemphigus is a group of autoimmune blistering diseases, potentially life-threatening. Rituximab received FDA approval in June 2018 for the treatment of moderate to severe pemphigus vulgaris. Objectives To evaluate the efficacy and safety of rituximab in patients with pemphigus, resistant to previous therapies or unable to receive classic immunosuppressive treatment due to serious adverse events or comorbidities. Materials and methods Twenty-five patients (9 men, 16 women), mean age 49.4 ± 15.9 years (range 21–74 years), mean disease duration 4 ± 2.7 years (range 0.25–10 years) were included in the study: 19 patients with pemphigus vulgaris and 6 with pemphigus foliaceous. The efficacy of rituximab was evaluated according to the control of disease, retention of remission, disease severity, previous treatments and adverse reactions. During COVID-19 pandemic patients are monitored closely through tele-dermatology. Results Twenty-three out of 25 patients had great improvement, 2 out of 25 ceased therapy due to adverse events (arthralgias and dyspnea). Sixteen out of 23 received additional course after 8 months (range 5–60 months). More aged patients presented more frequently adverse events and underwent additional courses (p = 0.002). Rituximab was found superior to classic immunosuppressive treatment in terms of efficacy and safety, with larger periods of remission and lower doses of corticosteroids and immunosuppressants. No major adverse events were noticed. Conclusions Rituximab is a very effective treatment of pemphigus and, remarkably, superior to classic immunosuppressive treatment.

Minerva Anestesiologica, 2021

BACKGROUND Leptin, the prototype adipokine, exerts immunomodulatory actions being implicated in i... more BACKGROUND Leptin, the prototype adipokine, exerts immunomodulatory actions being implicated in inflammatory responses during sepsis. Clinical evidence regarding its role in sepsis has been contradictory, while free leptin has not been studied. Our aim was to jointly investigate circulating total leptin, its soluble receptor (sOBR), and free leptin, as well as their kinetics in critically ill patients with sepsis regarding their diagnostic and prognostic value. METHODS In a prospective study, serum total leptin, sOBR and free leptin index (FLI) were determined in 102 critically ill patients with sepsis within 48 hours from sepsis onset and one week after enrollment, and in 102 age and gender-matched healthy controls. RESULTS Upon enrollment, total leptin, sOB-R and FLI were significantly higher in septic patients compared to controls and they were positively correlated with sepsis severity scores, while they presented a significant decrease during the first week (p<0.001). The decrease in total leptin and sOB-R was significantly higher in patients with sepsis compared to septic shock and in survivors compared to nonsurvivors at 28 days (p<0.001). Higher serum total leptin was independently associated with survival at 28 days (enrollment: HR 0.86, p=0.03; one week after: HR 0.77, p<0.001). Higher kinetics of total leptin (but not FLI) was independently associated with survival after adjustment (HR: 0.48, p=0.001). CONCLUSIONS Higher circulating total leptin and its higher kinetics during the first week from sepsis onset independently predict 28 day survival in critically ill patients. Free leptin did not present any additional diagnostic and prognostic value in sepsis.