Publications by authors named "Ourania S Kotsiou"

33 Publications

Underestimation of respiratory symptoms by smokers: a thorn in chronic obstructive pulmonary disease diagnosis.

NPJ Prim Care Respir Med 2021 03 12;31(1):14. Epub 2021 Mar 12.

Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, Larissa, Greece.

Primary care centers are ideal positions to identify chronic obstructive pulmonary disease (COPD). We determined the COPD prevalence among ever-smokers aged 40-65 years attending a 2-year program conducted in 22 Greek primary healthcare centers and made comparisons between genders, patients less than or greater than 55 years, and newly or previously diagnosed COPD patients. A total of 117 persons, after studying 1100 people, were diagnosed with previously unknown or known COPD, providing a COPD prevalence of 10.6% among the study population. In all, 7.5% of the participants were newly diagnosed with COPD. Women with COPD reported smoking less but experienced worse respiratory and depressive symptoms than men. A total of 19% of the COPD population below 55 years experienced wheezing and exacerbations more frequently than older patients. Newly diagnosed COPD patients were significantly younger, reported a significant burden of symptoms without seeking medical help. Primary health care has a crucial role in the early detection of COPD among unsuspecting smokers.
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http://dx.doi.org/10.1038/s41533-021-00226-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955112PMC
March 2021

The role of nitric oxide in pleural disease.

Respir Med 2021 Apr 23;179:106350. Epub 2021 Feb 23.

Department of Physiology, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece.

Nitric oxide (NO) regulates various physiological and pathophysiological functions in the lungs. However, there is much less information about the effects of NO in the pleura. The present review aimed to explore the available evidence regarding the role of NO in pleural disease. NO, has a double-edged role in the pleural cavity. It is an essential signaling molecule mediating various physiological cell functions such as lymphatic drainage of the serous cavities, the immune response to intracellular multiplication of pathogens, and downregulation of neutrophil migration, but also induces genocytotoxic and mutagenic effects when present in excess. NO is implicated in the pathogenesis of asbestos-related or exudative pleural disease and mesothelioma. From a clinical point of view, the fraction of exhaled NO has been suggested as a potential non-invasive tool for the diagnosis of benign asbestos-related disorders. Under experimental conditions, NO-mimetics were found to attenuate hypoxia-induced therapy resistance in mesothelioma. Similarly, hybrid agents consisting of an NO donor coupled with a parent anti-inflammatory drug showed an enhancement of the anti-inflammatory activity of anti-inflammatory drugs. However, given the paucity of research work performed over the last years in this area, further research should be undertaken to establish reliable conclusions with respect to the feasibility of determining or targeting the NO signaling pathway for pleural disease diagnosis and therapeutic management.
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http://dx.doi.org/10.1016/j.rmed.2021.106350DOI Listing
April 2021

HΜGB1/sRAGE levels differ significantly between transudates and exudates.

Cytokine 2021 May 16;141:155469. Epub 2021 Feb 16.

Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500 Larissa, Greece; Department of Physiology, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500 Larissa, Greece. Electronic address:

High mobility group box 1(HMGB1) protein operates as an alarmin with multiple roles in immunity and cell homeostasis. It is highly expressed in epithelial barrier sites and acts via the binding to the receptor for advanced glycation end products (RAGE). Production of HMGB1 and soluble RAGE (sRAGE), a decoy receptor for HMGB1, has been implicated in several pulmonary diseases, but both have been scarcely investigated in pleural diseases. The aim of this study was to determine the levels of HMGB1 and sRAGE in transudative, malignant and parapneumonic pleural effusions (PEs) and to investigate the effect of low and high HMGB1 pleural fluid levels on MeT-5A cell adhesion, migration and spheroid formation, in each group. HMGB1 and sRAGE levels were significantly lower and higher in transudative PEs compared to malignant and parapneumonic PEs, respectively. Patients above 65 years of age had significantly lower HMGB1 and higher sRAGE levels compared to patients below 65 years old. Furthermore, incubation of MeT-5A cells with malignant or parapneumonic PEs bearing low or high levels of HMGB1 yielded significant differential effects on MeT-5A cell adhesion, migration and spheroid formation. In all types of effusions, high HMGB1 levels correlated with more adherence compared to low HMGB1 levels. In transudative and malignant PEs high HMGB1 levels correlated with decreased migration of MeT-5A cells while in parapneumonic ones the effect was the opposite. Only samples from parapneumonic PEs high in HMGB1 achieved uniform spheroid formation. These results reveal a clinical context-dependent effect of the HMGB1/sRAGE axis in PEs.
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http://dx.doi.org/10.1016/j.cyto.2021.155469DOI Listing
May 2021

Repeated Antigen-Based Rapid Diagnostic Testing for Estimating the Coronavirus Disease 2019 Prevalence from the Perspective of the Workers' Vulnerability before and during the Lockdown.

Int J Environ Res Public Health 2021 02 9;18(4). Epub 2021 Feb 9.

Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41110 Larissa, Greece.

Background: No previous study has investigated the SARS-CoV-2 prevalence and the changes in the proportion of positive results due to lockdown measures from the angle of workers' vulnerability to coronavirus in Greece. Two community-based programs were implemented to evaluate the SARS-CoV-2 prevalence and investigate if the prevalence changes were significant across various occupations before and one month after lockdown.

Methods: Following consent, sociodemographic, clinical, and job-related information were recorded. The VivaDiag™ SARS-CoV-2 Antigen Rapid Test was used. Positive results confirmed by a real-time Reverse Transcriptase Polymerase Chain Reaction for SARS-COV-2.

Results: Positive participants were more likely to work in the catering/food sector than negative participants before the lockdown. Lockdown restrictions halved the new cases. No significant differences in the likelihood of being SARS-CoV-2 positive for different job categories were detected during lockdown. The presence of respiratory symptoms was an independent predictor for rapid antigen test positivity; however, one-third of newly diagnosed patients were asymptomatic at both time points.

Conclusions: The catering/food sector was the most vulnerable to COVID-19 at the pre-lockdown evaluation. We highlight the crucial role of community-based screening with rapid antigen testing to evaluate the potential modes of community transmission and the impact of infection control strategies.
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http://dx.doi.org/10.3390/ijerph18041638DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915907PMC
February 2021

Calprotectin in Lung Diseases.

Int J Mol Sci 2021 Feb 8;22(4). Epub 2021 Feb 8.

Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece.

Calprotectin (CLP) is a heterodimer formed by two S-100 calcium-binding cytosolic proteins, S100A8 and S100A9. It is a multifunctional protein expressed mainly by neutrophils and released extracellularly by activated or damaged cells mediating a broad range of physiological and pathological responses. It has been more than 20 years since the implication of S100A8/A9 in the inflammatory process was shown; however, the evaluation of its role in the pathogenesis of respiratory diseases or its usefulness as a biomarker for the appropriate diagnosis and prognosis of lung diseases have only gained attention in recent years. This review aimed to provide current knowledge regarding the potential role of CLP in the pathophysiology of lung diseases and describe how this knowledge is, up until now, translated into daily clinical practice. CLP is involved in numerous cellular processes in lung health and disease. In addition to its anti-microbial functions, CLP also serves as a molecule with pro- and anti-tumor properties related to cell survival and growth, angiogenesis, DNA damage response, and the remodeling of the extracellular matrix. The findings of this review potentially introduce CLP in daily clinical practice within the spectrum of respiratory diseases.
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http://dx.doi.org/10.3390/ijms22041706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915440PMC
February 2021

Fighting with the Lernean Hydra: Greek Humanitarian Crisis Enters Worst-Case Scenario. Comment on: Joseph, L.; Ismail, S.A.; Gunst, M.; Jarman, K.; Prior, D.; Harris, M.; Abbara, A. A Qualitative Research Study Which Explores Humanitarian Stakeholders' Views on Healthcare Access for Refugees in Greece. 2020, , 6972.

Int J Environ Res Public Health 2020 11 9;17(21). Epub 2020 Nov 9.

Metsovion Interdisciplinary Research Center, National Technical University of Athens, 44200 Athens, Greece.

Liz Joseph and collaborators shed light upon the real challenges of securing health during the Greek humanitarian crisis from the point of view of the key stakeholders in healthcare access, reflecting the need to reform a range of different contexts and types of humanitarian response [...].
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http://dx.doi.org/10.3390/ijerph17218253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7664909PMC
November 2020

Letter to Editor regarding Prata et al. (2020), Temperature significantly changes COVID-19 transmission in (sub)tropical cities of Brazil. Science of Total Environment, v729, 138862.

Sci Total Environ 2020 12 28;746:141323. Epub 2020 Jul 28.

Respiratory Medicine Department, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41110 Larissa, Thessaly, Greece.

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http://dx.doi.org/10.1016/j.scitotenv.2020.141323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385549PMC
December 2020

Serum vitamin D levels in patients with obstructive sleep apnea syndrome and level changes after continuous positive airway pressure therapy.

Sleep Breath 2020 Aug 1. Epub 2020 Aug 1.

Laboratory of Respiratory Sleep Disorders, Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece.

Purpose: Patients with obstructive sleep apnea syndrome (OSAS) have been found to exhibit lower serum vitamin D levels, even when the control groups are matched for confounding conditions. However, contradictory studies are also present. This study aimed to compare serum 25-hydroxyvitamin D (25(OH)D) levels between adult patients with OSAS and non-apneic controls and to evaluate the changes in 25(OH)D levels after 3 and 12 months of continuous positive airway pressure (CPAP) therapy.

Methods: The study was comprised of 30 patients with OSAS and 30 controls. Serum 25(OH)D levels were determined at baseline and after 3 and 12 months of CPAP therapy in all patients with OSAS. For analysis, patients with OSAS were divided into subgroups by adherence, with adherence defined as CPAP usage for > 4 h per night on at least 70% of nights.

Results: The 25(OH)D levels were not significantly different between OSAS and control groups at baseline. 25(OH)D levels did not change after 3 and 12 months of CPAP therapy. Patients who were CPAP-adherent showed less reduction in 25(OH)D levels compared with non-adherent ones (21.18 ± 9.3 vs. 12.13 ± 3.8 ng/mL, p = 0.022) after 1 year. The 25(OH)D levels were significantly correlated with higher daily CPAP usage at 3 and 12 months. Mean daily CPAP usage was a significant predictor of serum 25(OH)D levels at 12 months.

Conclusions: Patients with OSAS who demonstrated good CPAP adherence showed significantly higher 25(OH)D levels after 1 year compared with those not adequately using CPAP. Long-term good CPAP adherence and highly daily CPAP usage positively affected 25(OH)D levels in patients with OSAS.
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http://dx.doi.org/10.1007/s11325-020-02146-6DOI Listing
August 2020

Common variable immunodeficiency and asthma: Coexistence or coincidence?

Ann Allergy Asthma Immunol 2020 06;124(6):635

Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece. Electronic address:

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http://dx.doi.org/10.1016/j.anai.2020.02.013DOI Listing
June 2020

Clinical profile of severe asthmatics receiving biological treatment: see behind the scenes.

J Asthma 2020 Apr 14:1-3. Epub 2020 Apr 14.

Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece.

The clinical phenotyping of severe asthma could improve treatment outcomes, quality of life, morbidity, and mortality of asthma patients. The growing availability of rich clinical data could provide opportunities to address a broad range of real-world questions regarding clinical phenotyping and effective therapeutic approaches of severe asthma. Accordingly, in this Letter to the Editor, we provide data relevant to constructing the clinical profile of a Greek severe asthma patient cohort who receive biological treatment.
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http://dx.doi.org/10.1080/02770903.2020.1750629DOI Listing
April 2020

Enhanced Public Interest in Response to the Refugee and Healthcare Crises in Greece.

Int J Environ Res Public Health 2020 03 27;17(7). Epub 2020 Mar 27.

Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41110 Larissa, Greece.

: The Greek National Health System (NHS) has been profoundly affected by the synergy of the economic and refugee crises. We aimed at evaluating the public interest regarding refugee and healthcare issues in Greece. : Google Trends was employed to normalize traffic data on a scale from 0 to 100, presented as monthly relative search volume (RSV) for the search term queries: "refugees", "health", "diseases", "hospital", and "economic crisis" in Greece, from the period 2008 to 2020. Cross-country comparisons in selected European countries were made. : The analysis of RSV data showed an upward trend for the keyword "refugee", in Greece, in the last five years, with two remarkable peaks from 2015 to 2016 and from 2019 to the present. Interest regarding refugees was more prevalent in the Aegean islands compared to the mainland. The mass influx of refugees has been linked to disease-related concerns. The search terms "hospital" and "health" have been the most popular and constantly quested topics since the beginning of the economic crisis in Greece, in 2009. Similar trends existed across Europe. : There is an urgent need for effective public awareness of current politico-ethical and social-economic conditions. The patterns of public interest can formulate public policy.
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http://dx.doi.org/10.3390/ijerph17072272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177306PMC
March 2020

Fractional exhaled nitric oxide: where there is smoke, there is fire.

J Asthma 2020 Jan 12:1-2. Epub 2020 Jan 12.

Asthma External Unit, Faculty of Medicine, Department of Respiratory Medicine, University of Thessaly, BIOPOLIS, Larissa, Greece.

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http://dx.doi.org/10.1080/02770903.2020.1713146DOI Listing
January 2020

When the brain hurts the lung: neurogenic pulmonary edema following a first epileptic seizure.

Epileptic Disord 2019 12;21(6):608-610

Respiratory Medicine Department, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41110, Larissa, Greece.

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http://dx.doi.org/10.1684/epd.2019.1113DOI Listing
December 2019

A hiding in the lining: Irregular wide-complex tachycardia due to atrial fibrillation in Wolff-Parkinson-White syndrome.

Pacing Clin Electrophysiol 2019 11 16;42(11):1499-1500. Epub 2019 Oct 16.

Department of Cardiology, General Hospital of Lamia, Papasiopoulou, 35100, Lamia, Fthiotida, Greece.

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http://dx.doi.org/10.1111/pace.13804DOI Listing
November 2019

Necessity of co-operation between pulmonologists and internists in tuberculous pleurisy diagnosis.

Expert Rev Respir Med 2019 11 13;13(11):1037. Epub 2019 Sep 13.

Respiratory Medicine Department, Faculty of Medicine, University of Thessaly , 41500 , Larissa , Greece.

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http://dx.doi.org/10.1080/17476348.2019.1667234DOI Listing
November 2019

Antithrombotic therapy for elderly patients with acute coronary syndrome: reasons to be cautious.

Eur Heart J Cardiovasc Pharmacother 2020 01;6(1):69

Department of Cardiology, General Hospital of Lamia, Papasiopoulou, Lamia, Fthiotida, Greece.

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http://dx.doi.org/10.1093/ehjcvp/pvz042DOI Listing
January 2020

Pleural Effusion IL-33/sST2 Levels and Effects of Low and High IL-33/sST2 Levels on Human Mesothelial Cell Adhesion and Migration.

Inflammation 2019 Dec;42(6):2072-2085

Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, 41500, Larissa, Greece.

Interleukin 33 (IL-33) is an alarmin with multiple roles in immunity and cell homeostasis, highly expressed in barrier sites, acting via the suppression of tumorigenicity 2 receptor (ST2). Production of IL-33 and soluble ST2 (sST2), a decoy receptor for IL-33, has been implicated in several pulmonary diseases, but both have been scarcely investigated in pleural diseases. The aim of this study was to determine the levels of IL-33 and sST2 in transudative (TrPEs), malignant (MPEs), and parapneumonic (PPEs) pleural effusions (PEs) and investigate the effect of PE fluids from each group with low and high IL-33/sST2 levels on MeT-5A cell adhesion and migration. IL-33 and sST2 pleural fluid levels were similar among TrPEs, MPEs, and PPEs. However, a significant correlation was found between IL-33 and LDH and in sST2 levels with lymphocyte counts in TrPEs. Additionally, in MPEs the levels of IL-33 correlated with the levels of sST2 and with the red blood cell counts. Furthermore, incubation of MeT-5A cells with MPEs and PPEs bearing low or high levels of IL-33/sST2 yielded significant differential effects on MeT-5A cell adhesion and migration. In MPEs, high IL-33/sST2 levels led to increased adhesion and migration of MeT-5A cells, while in PPEs the effect was the opposite, while no effect in both cell phenotypes was determined for TrPEs. These results reveal a clinical context dependent effect of the IL-33/sST2 axis in PEs.
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http://dx.doi.org/10.1007/s10753-019-01070-6DOI Listing
December 2019

Transcutaneous carbon dioxide monitoring as a predictive tool for all-cause 6-month mortality after acute pulmonary embolism.

Eur J Intern Med 2019 Oct 12;68:44-50. Epub 2019 Aug 12.

Department of Critical Care, University Hospital of Larissa, BIOPOLIS, 41500 Larissa, Greece.

Background: Pulmonary embolism (PE) frequently remains undiagnosed. The partial pressure of carbon dioxide (Pa) a surrogate of dead-space ventilation, is useful in the evaluation of the degree of pulmonary artery occlusion. At present, there is no knowledge about the prognostic role of Pa variations during the first hours of an acute PE. Transcutaneous measurement of CO (Ptc) is a simple, non-invasive method that correlates well with Pa levels, evaluated in this study for the first time in patients with PE.

Purpose: To assess the correlation between Ptc and Pa levels in the acute phase of PE and the role of Ptc in predicting 6-months mortality.

Methods: This was a pilot study including 53 patients with acute PE who hospitalized in Respiratory Medicine Department at University Hospital of Larissa in central Greece during 15 months. Ptc was constantly monitored for four hours after PE diagnosis with the TCM40 monitoring system (SmartCal). Simultaneous arterial blood gas measurements were performed. Each patient was prospectively recorded for six months via standard telephone calls.

Results: Pa and Ptc values were well-correlated in the acute phase of PE. Decreased Ptc levels in the first monitoring hour were associated with a higher risk of mortality. In the PE subgroup who died, the lower Ptc level in the first hour of PE was a predictor of shorter survival time independently of gender, age, comorbidities, and smoking status.

Conclusion: Ptc measurement, especially in the first hour after PE, seemed to be a valid tool in predicting all-cause 6-month mortality.
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http://dx.doi.org/10.1016/j.ejim.2019.07.030DOI Listing
October 2019

Exhaled nitric oxide as a marker of chlorine exposure in young asthmatic swimmers.

Ann Allergy Asthma Immunol 2019 09 25;123(3):249-255. Epub 2019 Jun 25.

Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece.

Background: Swimming is recommended for people with asthma. However, the inevitable exposure to chlorine and its disinfectant byproducts in indoor swimming pools could be responsible for bronchial inflammation and asthma development. Fractional exhaled nitric oxide (FeNO) is a noninvasive marker of airway inflammation that predicts asthma exacerbations.

Objectives: To evaluate pretraining and posttraining FeNO levels in young swimmers with asthma attending an indoor chlorinated pool compared with a set of healthy swimmers and to examine the potential risk of exposure to chlorine as a factor associated with bronchial inflammation.

Methods: A total of 146 children (8-18 years old) constantly attending an indoor chlorinated swimming pool were enrolled. Spirometry and FeNO measurements were performed 30 minutes after their arrival at the pool and immediately after exercise. Pre-exercise and postexercise spirometric and FeNO levels were assessed in a random subgroup of 14 swimmers (10 with asthma and 4 without) who performed cardiopulmonary exercise testing.

Results: Asthma was detected in 23 swimmers. In swimmers with asthma, preswimming FeNO values were significantly elevated compared with swimmers without asthma and their FeNO values measured before cardiopulmonary exercise testing. Postexercise FeNO values were significantly decreased by approximately one-third in healthy children and children with asthma in all sporting backgrounds. However, postswimming FeNO values remained significantly higher in swimmers with asthma compared with those without asthma. Forced expiratory volume in 1 second (FEV), forced vital capacity (FVC), and FEV/FVC ratio values showed no significant difference before and after 2 types of activity.

Conclusion: Elevated FeNO levels before and after swimming were recorded in swimmers with asthma not observed in a different exercise field. The presence of chlorine in the indoor swimming pool seems to explain this finding.
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http://dx.doi.org/10.1016/j.anai.2019.06.008DOI Listing
September 2019

A case report of mesalazine-induced lung injury: A reversible drug side effect.

Respir Med Case Rep 2019 27;27:100865. Epub 2019 May 27.

Respiratory Medicine Department, University of Thessaly School of Medicine, Biopolis, 41110 Larissa, Thessaly, Greece.

Introduction: Mesalazine is widely used in the treatment of the acute and maintenance phase of ulcerative colitis (UC). The possibility of interstitial lung disease being induced by mesalazine in the form of eosinophilic pneumonia, organizing pneumonia, and nonspecific interstitial pneumonia has been acknowledged for decades. However, mesalazine-related hypersensitivity pneumonitis (HP) constitutes an infrequent entity.

Case Report: A 55-year-old Caucasian man, with a six-month medical history of UC under long-term maintenance treatment with oral mesalazine, presented with a week-long low-grade fever, dry cough and a diffuse bilateral centrilobular ill-defined micronodular pattern in chest imaging. On examination, he had dyspnea with hypoxemic respiratory failure. After extensive workup, potential differential diagnoses such as pulmonary infections were ruled out. Bronchoalveolar lavage (BAL) cellular analysis demonstrated a predominance of lymphocytes and an eosinophilia. The transbronchial biopsy findings confirmed lymphocytic alveolitis. The diagnosis of subacute HP was made with confidence because of the compatible clinical, radiographic, physiologic, BAL and histopathologic findings. Mesalazine withdrawal was decided. Substantial clinical improvement was promptly noticed. The fever abated within 24 hours alongside with a significant improvement of arterial oxygen saturation and lung function parameters. A radiological recovery was also gradually noticed.

Conclusions: Mesalazine-induced HP has been scarcely described in the literature. This Case indicates that HP is a rare but real entity in UC patients on continuous oral mesalazine treatment; its possibility should also be considered when unexplained respiratory symptoms develop during therapy. Amelioration of symptoms, imaging, and lung function improvement seem to occur only upon the abrupt drug discontinuation.
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http://dx.doi.org/10.1016/j.rmcr.2019.100865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6545345PMC
May 2019

Pleural effusions induced by human herpesviruses in the immunocompetent host.

Infect Dis (Lond) 2019 Mar 24;51(3):189-196. Epub 2019 Jan 24.

b Department of Physiology , Faculty of Medicine, University of Thessaly, BIOPOLIS , Larissa , Greece.

Methods: A computer-based search of the English literature for articles relative to Human Herpesviruses (HHVs) infection and pleural effusions (PEs) in the immunocompetent host was performed in PubMed and Scopus. The reference lists of the retrieved articles were also reviewed for relevant articles.

Results: A total of 20 articles satisfied the selection criteria and were included in the study. In the majority of the articles, PEs were reported as clinical complications of systemic HHV-induced infection. The frequency of HHVs within the reported cases was five for HHV-1/2, one for HHV-3, six for HHV-4, six for HHV-5 and one for HHV-6. One case involved HHV-4 and HHV-5 co-infection. No case of HHV-7 or HHV-8 related PE in the immunocompetent host was retrieved.

Conclusions: Pleural effusions in the immunocompetent host occur in severe viral infections and can be due to comorbidities (or septic complications) or due to the direct HHV pathogenicity although research relative to the susceptibility of pleural mesothelial cells to HHV infection is lacking. HHV pathogenicity needs to be studied further as it could explain undiagnosed PEs.
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http://dx.doi.org/10.1080/23744235.2018.1551620DOI Listing
March 2019

Detection of mitochondrial transfer RNA (mt-tRNA) gene mutations in patients with idiopathic pulmonary fibrosis and sarcoidosis.

Mitochondrion 2018 11 26;43:43-52. Epub 2018 Oct 26.

Department of Biochemistry & Biotechnology, University of Thessaly, BIOPOLIS, Larissa 41110, Greece.

Mitochondrial reactive oxygen species production may lead to tissue injury associated with two respiratory disorders of unknown origin which are shared by common tissue fibrosis, IPF and sarcoidosis. Sequence analysis of 22 mt-tRNA genes and parts of their flanking genes revealed 32 and 45 mutations in 38/40 IPF and 69/85 sarcoidosis patients respectively. 4 novel mutations were identified. 15/32 and 25/45 mutations were exclusively expressed while 12/32 and 17/45 mutations predominantly occurred in IPF and sarcoidosis group respectively, compared to healthy controls. Novel mutation combinations were solely expressed in disease. Hence, a mitochondrial-mediated pathogenic pathway seems to underlie both entities.
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http://dx.doi.org/10.1016/j.mito.2018.10.004DOI Listing
November 2018

IL-33/ST2 Axis in Organ Fibrosis.

Front Immunol 2018 24;9:2432. Epub 2018 Oct 24.

Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, BIOPOLIS, Larissa, Greece.

Interleukin 33 (IL-33) is highly expressed in barrier sites, acting via the suppression of tumorigenicity 2 receptor (ST2). IL-33/ST2 axis has long been known to play a pivotal role in immunity and cell homeostasis by promoting wound healing and tissue repair. However, it is also involved in the loss of balance between extensive inflammation and tissue regeneration lead to remodeling, the hallmark of fibrosis. The aim of the current review is to critically evaluate the available evidence regarding the role of the IL-33/ST2 axis in organ fibrosis. The role of the axis in tissue remodeling is better understood considering its crucial role reported in organ development and regeneration. Generally, the IL-33/ST2 signaling pathway has mainly anti-inflammatory/anti-proliferative effects; however, chronic tissue injury is responsible for pro-fibrogenetic responses. Regarding pulmonary fibrosis mature IL-33 enhances pro-fibrogenic type 2 cytokine production in an ST2- and macrophage-dependent manner, while full-length IL-33 is also implicated in the pulmonary fibrotic process in an ST2-independent, Th2-independent fashion. In liver fibrosis, evidence indicate that when acute and massive liver damage occurs, the release of IL-33 might act as an activator of tissue-protective mechanisms, while in cases of chronic injury IL-33 plays the role of a hepatic fibrotic factor. IL-33 signaling has also been involved in the pathogenesis of acute and chronic pancreatitis. Moreover, IL-33 could be used as an early marker for ulcer-associated activated fibroblasts and myofibroblast trans-differentiation; thus one cannot rule out its potential role in inflammatory bowel disease-associated fibrosis. Similarly, the upregulation of the IL-33/ST2 axismay contribute to tubular cell injury and fibrosis via epithelial to mesenchymal transition (EMT) of various cell types in the kidneys. Of note, IL-33 exerts a cardioprotective role via ST2 signaling, while soluble ST2 has been demonstrated as a marker of myocardial fibrosis. Finally, IL-33 is a crucial cytokine in skin pathology responsible for abnormal fibroblast proliferation, leukocyte infiltration and morphologic differentiation of human endothelial cells. Overall, emerging data support a novel contribution of the IL-33/ST2 pathway in tissue fibrosis and highlight the significant role of the Th2 pattern of immune response in the pathophysiology of organ fibrosis.
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http://dx.doi.org/10.3389/fimmu.2018.02432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207585PMC
October 2019

Impact of the Refugee Crisis on the Greek Healthcare System: A Long Road to Ithaca.

Int J Environ Res Public Health 2018 08 20;15(8). Epub 2018 Aug 20.

Inselspital, University Hospital Bern, 3010 Bern, Switzerland.

Greece is the country of "Xenios Zeus", the Ancient Greek god of foreigners and hospitality; however, it is also the main point of entry to Europe. Since the beginning of 2014, 1,112,332 refugees crossed the borders of Greece. Overall, 33,677 children and adolescent refugees sought asylum in Greece from 2013 to 2017, while 57,042 refugees are currently being hosted. The rapid entry of refugees into Greece raised the critical issue of health policy. The Greek National Health Service (NHS) faces many challenges. Adequate economic and human support is essential if this situation is to be managed successfully. However, Greece still bears the burden of the economic downturn since 2009. In fact, the crisis led to shortages in crucial equipment, and unmet health needs for both locals and refugees. The NHS deals with traumatic experiences, as well as cultural and linguistic differences. Overcrowded reception centers and hotspots are highly demanding and are associated with severe disease burden. This highlights the importance of guidelines for medical screening, healthcare provision, and a well-managed transition to definitive medical facilities. Furthermore, non-governmental organizations make an essential contribution by ensuring appropriate support to refugee minors, especially when they experience poor access to the NHS.
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http://dx.doi.org/10.3390/ijerph15081790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6121252PMC
August 2018

The Emergency Medical System in Greece: Opening Aeolus' Bag of Winds.

Int J Environ Res Public Health 2018 04 13;15(4). Epub 2018 Apr 13.

Respiratory Medicine Department, Faculty of Medicine, University of Thessaly, Biopolis, 41500 Larissa, Greece.

An Emergency Medical Service (EMS) system must encompass a spectrum of care, with dedicated pre-hospital and in-hospital medical facilities. It has to be organised in such a way as to include all necessary services—such as triage accurate initial assessment, prompt resuscitation, efficient management of emergency cases, and transport to definitive care. The global economic downturn has had a direct effect on the health sector and poses additional threats to the healthcare system. Greece is one of the hardest-hit countries. This manuscript aims to present the structure of the Greek EMS system and the impact of the current economic recession on it. Nowadays, primary care suffers major shortages in crucial equipment, unmet health needs, and ineffective central coordination. Patients are also facing economic limitations that lead to difficulties in using healthcare services. The multi-factorial problem of in-hospital EMS overcrowding is also evident and has been linked with potentially poorer clinical outcomes. Furthermore, the ongoing refugee crisis challenges the national EMS. Adoption of a triage scale, expansion of the primary care network, and an effective primary–hospital continuum of care are urgently needed in Greece to provide comprehensive, culturally competent, and high-quality health care.
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http://dx.doi.org/10.3390/ijerph15040745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5923787PMC
April 2018

Fractional exhaled nitric oxide: Signaling lung function changes in obstructive lung diseases.

Ann Allergy Asthma Immunol 2018 03;120(3):340

Department of Respiratory Medicine, University of Thessaly School of Medicine, BIOPOLIS, Larissa, Thessaly, Greece.

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http://dx.doi.org/10.1016/j.anai.2017.12.001DOI Listing
March 2018

Missed diagnosis and overtreatment of COPD among smoking primary care population in Central Greece: old problems persist.

Int J Chron Obstruct Pulmon Dis 2018 5;13:487-498. Epub 2018 Feb 5.

Department of Respiratory Medicine, School of Medicine, University of Thessaly, Biopolis, Larissa, Thessaly, Greece.

Background: The diagnosis of COPD is not always consistent with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy in daily clinical practice, especially in primary care. This study aimed to estimate the overall COPD prevalence and severity, to identify differences between newly and previously diagnosed patients, and to evaluate the potential COPD overtreatment in a smoking population attending a primary care spirometry surveillance program.

Methods: A study was conducted in 10 primary health care centers of Central Greece during a 7-month period. Eligible participants were aged ≥40 years and were either current smokers or exsmokers.

Results: A total of 186 subjects were included (68% males, mean age 62.3±12.6 years, mean life-time tobacco exposure 50 pack-years). COPD prevalence was 17.8%, identified to be higher in elderly males. Forty-two percent of the COPD group were newly diagnosed patients, who were of younger age, current smokers, presented with less dyspnea and better health status, and mainly appeared with mild-to-moderate disease. Interestingly, 61.4% of non-COPD and 85.7% of newly diagnosed COPD individuals had been using inhaled medication under primary care provider's prescription without ever undergoing spirometry or further evaluation by a pulmonologist; thus, the phenomena of COPD overdiagnosis and missed diagnosis came into the spotlight. Moreover, only 26.3% of known COPD patients were properly medicated according to GOLD guidelines, while half of them were inappropriately treated with triple inhaled therapy.

Conclusion: We reported a significant prevalence of COPD in smoking population attending this spirometry program. A remarkable proportion of COPD patients were undiagnosed and made case finding worthwhile. Underutilization of spirometry in the diagnosis and management of COPD as well as general practitioners' nonadherence to the GOLD treatment guidelines was confirmed by our data. These findings highlight the need for a major overhaul and culture change in primary care settings of Central Greece.
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http://dx.doi.org/10.2147/COPD.S147628DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5804734PMC
September 2018

Impact of the financial crisis on COPD burden: Greece as a case study.

Eur Respir Rev 2018 Mar 24;27(147). Epub 2018 Jan 24.

Dept of Respiratory Medicine, Faculty of Medicine, University of Thessaly, BIOPOLIS, Larissa, Greece.

Poverty and low socioeconomic status have been associated with chronic obstructive pulmonary disease (COPD). The current financial crisis has forced millions back into poverty. Greece is one of the countries hit the hardest, and is in the middle of a deep ongoing collapse. There have been early reports stating the apparent effects of the Greek downturn on respiratory health. This review summarises the overall impact of the financial crisis on COPD burden throughout the period of economic downturn by analysing the case study of Greece. In all levels of the healthcare system, current economic restrictions have reduced the capacity to prevent, diagnose and treat COPD in parallel with current higher detection rates of COPD. Remarkably, expenditure on healthcare has been reduced by >25%, resulting in major healthcare equipment shortages. Lower wages (by up to 20%) and higher co-payments of up to 25% of a drug's purchase price have led to patients struggling to afford inhaled medications. Treatment nonadherence has been reported, resulting in 11.5% more exacerbations and 14.1% more hospitalisations annually, while the mean cost per severe COPD exacerbation has been approximated as €2600. Greece is a noteworthy example illustrating how COPD burden, quality of care and patients' outcome can be affected by economic crisis.
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http://dx.doi.org/10.1183/16000617.0106-2017DOI Listing
March 2018

Repeatability of pleural adenosine deaminase measurements in diagnostic evaluation of pleural effusions.

J Clin Lab Anal 2018 Jun 7;32(5):e22371. Epub 2017 Dec 7.

Department of Respiratory Medicine, School of Medicine, University of Thessaly, Larissa, Greece.

Background: A follow-up thoracentesis is proposed in suspected atypical tuberculosis cases. The study aimed to define the variability of pleural ADA values across repeated thoracenteses in different types of pleural effusions (PEs) and to evaluate whether ADA variance, in regard to the cutoff value of 40 U/L, affected final diagnosis.

Methods: A total of 131 patients with PEs of various etiologies underwent three repeated thoracenteses. ADA values were subsequently estimated.

Results: 82% and 55% of patients had greater than 10% and 20% deviation from the highest ADA value, respectively. From those patients who had a variance of 20%, 36% had only increasing ADA values, while 19% had only decreasing values. Considering the cutoff value of 40 U/L, only in two cases, ADA decreased below this threshold, which concerned a man with tuberculous pleurisy and a woman with lymphoma both in the course of treatment. Furthermore, only in two cases with rising values, ADA finally exceeded the cutoff limit, which concerned a man with rheumatoid pleurisy and a man with tuberculous pleurisy. Surprisingly, malignant PEs (MPEs) showed a higher percentage of increasing values compared to all other exudates that did not, however, exceed the threshold.

Conclusion: The determination of pleural ADA levels is a reproducible method for rapid tuberculosis diagnosis. The detected measurement deviations do not appear to affect final diagnosis. In specific situations, repeated ADA measurements may be valuable in directing further diagnostic evaluation. More investigation is needed to elucidate the possible prognostic significance of the increasing trend in ADA values in MPEs.
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http://dx.doi.org/10.1002/jcla.22371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6816856PMC
June 2018

Letter by Kotsiou and Gourgoulianis Regarding Article, "Pathophysiology of Takotsubo Syndrome".

Circulation 2017 12;136(23):2291-2292

Department of Respiratory Medicine, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, Greece.

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http://dx.doi.org/10.1161/CIRCULATIONAHA.117.030361DOI Listing
December 2017