Abstract Objectives The goal of this study was to assess the independent and collective diagnostic value of various modalities in cardiac sarcoidosis, delineate the role of cardiac magnetic resonance ...(CMR), and identify patients at risk. Background Cardiac sarcoidosis is associated with increased morbidity and mortality. CMR is a key modality in the evaluation of patients with cardiac symptoms, but the complementary role of CMR to conventional tests for the diagnosis of cardiac sarcoidosis is not fully defined. Methods Patients (N = 321) with biopsy-proven sarcoidosis underwent conventional cardiac testing and CMR with late gadolinium enhancement (LGE) and were followed up for primary (composite of all-cause mortality, sustained ventricular tachycardia VT episodes, or hospitalization for heart failure) and secondary (nonsustained VT episodes) endpoints. Results Cardiac sarcoidosis was diagnosed in 29.9% of patients according to the Heart Rhythm Society consensus criteria. CMR was the most sensitive and specific test (area under the curve: 0.984); it detected 44 patients with cardiac symptoms and/or electrocardiogram (ECG) abnormalities but normal echocardiogram, as well as 15 asymptomatic patients with normal baseline testing. Echocardiography added to cardiac history and ECG did not change sensitivity of the initial screening strategy (68.8% vs. 72.9%). Despite a high positive predictive value (83.9%), echocardiography had a low sensitivity (27.1%). During follow-up, 7.2% of patients reached the primary endpoint and another 3.4% reached the secondary endpoint. LGE was and independent predictor of primary endpoints (hazard ratio: 5.68; 95% CI: 1.74 to 18.49; p = 0.004). LGE, age, and baseline nonsustained VT were independent predictors of all events. In patients with cardiac symptoms and/or an abnormal ECG, CMR increased diagnostic accuracy and independently predicted primary endpoints (hazard ratio: 12.71; 95% confidence interval: 1.48 to 109.35; p = 0.021). Conclusions Of all cardiac tests, CMR was the most valuable in the diagnosis and prognosis of cardiac sarcoidosis in a general sarcoidosis population. Echocardiography had an overall limited diagnostic value as a screening test, and an abnormal study, despite a high positive predictive value, may still need confirmation with CMR.
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide accompanied by a substantial social and economic burden for the patient and the society. Poor ...sleep quality among COPD patients is frequently unnoticed and unaddressed by physicians and patients themselves, although it is a major source of further deterioration of these patients' quality of life. The aim of the present study was to record the quality of sleep in COPD patients among the Greek population and correlate these findings with various features of these patients, using the COPD and Asthma Sleep Impact Scale (CASIS). This was a cross-sectional observational study. Forty different variables (demographics, vital sign measurements, COPD-related medical history parameters, comorbidities, CASIS questionnaire results, COPD assessment test, COPD severity based on spirometry measurements, COPD stage based on the ABCD assessment approach, inhaled COPD treatment report) were collected from 3454 nation-wide COPD patients (Greece). The study sample consisted of COPD patients, mainly male (73%) with a median age of 69 years and a median BMI of 27.2. More than half of COPD patients (60.6%) suffered from moderate disease severity and 23.8% from severe disease, while less than half (42.1%) suffered from at least one exacerbation of the disease over the last year prior study enrollment. About 14% reported frequent to very frequent issues affecting their sleep quality, between a fourth and a third of them reported occasional night sleep disturbances, and at least half of them reported no or very infrequent problems in their night sleep. Our study indicates that the COPD assessment test (CAT) and the spirometry-based disease severity can predict the poorness in the quality of sleep (F
= 1397.5, p < 0.001, adj. R2 = 0.45) as assessed by CASIS score, and that the latter also correlates with age (ρ = 0.122, p < 0.001) and disease duration (ρ = 0.104, p < 0.001). On the contrary, there appears to be no correlation between sleep quality and number of exacerbations. Finally, untreated patients with COPD suffer from poorer quality of sleep compared to treated subjects, independently of the use of inhaled corticosteroids (F
= 21.65, p < 0.001). The results of the SLEPICO study show that increased age, prolonged disease duration, and especially CAT score ≥ 10, and severe COPD stage, might act as important indicators for deterioration in the quality of sleep, with potential consequences in the daily routine of those patients, thus urging potentially for further pharmacological interventions or modifications.
The trajectory from moderate and severe COVID-19 into acute respiratory distress syndrome (ARDS) necessitating mechanical ventilation (MV) is a field of active research. We determined serum levels ...within 24 h of presentation of 20 different sets of mediators (calprotectin, pro- and anti-inflammatory cytokines, interferons) of patients with COVID-19 at different stages of severity (asymptomatic, moderate, severe and ARDS/MV). The primary endpoint was to define associations with critical illness, and the secondary endpoint was to identify the pathways associated with mortality. Results were validated in serial measurements of mediators among participants of the SAVE-MORE trial. Levels of the proinflammatory interleukin (IL)-8, IL-18, matrix metalloproteinase-9, platelet-derived growth factor (PDGF)-B and calprotectin (S100A8/A9) were significantly higher in patients with ARDS and MV. Levels of the anti-inflammatory IL-1ra and IL-33r were also increased; IL-38 was increased only in asymptomatic patients but significantly decreased in the more severe cases. Multivariate ordinal regression showed that pathways of IL-6, IL-33 and calprotectin were associated with significant probability for worse outcome. Calprotectin was serially increased from baseline among patients who progressed to ARDS and MV. Further research is needed to decipher the significance of these findings compared to other acute-phase reactants, such as C-reactive protein (CRP) or ferritin, for the prognosis and development of effective treatments.
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with multiple systemic manifestations and comorbidities, which contribute independently to its total morbidity and mortality. ...Pulmonary rehabilitation is an evidence-based intervention that is indicated for COPD patients who remain symptomatic, despite optimal pharmacological therapy. Although it is well documented in pure COPD, the role of pulmonary rehabilitation is uncertain in coexisting comorbidities. The aim of the present study was to clarify the effect of a pulmonary rehabilitation program in COPD patients with concomitant comorbidities.
Thirty two patients with COPD were evaluated before and after a comprehensive pulmonary rehabilitation program, in terms of dyspnea, quality of life (QOL), pulmonary function tests and exercise capacity. The patients were also divided into two groups, according to the presence or the absence of comorbidities. Patients with none or only one comorbidity (Group 1,
= 11) were compared to those who had two or more comorbidities (Group 2,
= 21).
All patients significantly improved in dyspnea, as expressed by modified Medical Research Council scale and the COPD assessment Test (
< 0.001), QOL as assessed by the St. George respiratory questionnaire (
< 0.001) and exercise tolerance in six minute walking test (
< 0.001). Peak oxygen uptake relatively increased and body mass decreased in Group 1 compared to Group 2 (
< 0.05).
Pulmonary rehabilitation in COPD seems to be beneficial for all patients, independently of the presence, the number or the nature of their comorbidities. Thus, the presence of comorbidities must not represent an exclusion criterion for patients that are referred to pulmonary rehabilitation programs.
Current controlled trials ISRCTN14648515 Retrospectively registered 15 February 2018.
Abstract
Background
Chronic obstructive pulmonary disease (COPD) is a multifactorial clinical condition, characterized by chronic progressive (or worsening) respiratory symptoms, structural pulmonary ...abnormalities, and impaired lung function, and is often accompanied by multiple, clinically significant comorbid disorders. In 2017, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) issued a new report on COPD prevention, diagnosis and management, aiming at personalizing the maintenance therapeutic approach of the stable disease, based on the patients’ symptoms and history of exacerbations (ABCD assessment approach). Our objective was to evaluate the implementation of GOLD suggestions in everyday clinical practice in Greece.
Methods
This was a cross-sectional observational study. Sixty-five different variables (demographics, vital sign measurements, COPD-related medical history parameters, comorbidities, vaccination data, COPD severity based on spirometry measurements, COPD stage based on the ABCD assessment approach, COPD treatments) were collected from 3615 nation-wide COPD patients (Greece).
Results
The mean age at the time of initial COPD diagnosis was 63.8 (± 10.2). Almost 60% of the subjects were classified into group B, while the remaining patients were falling into groups A (18%) and D (21%), and only a small minority of patients belonged to Group C, according to the ABCD assessment approach. The compliance of respiratory physicians to the GOLD 2017 therapeutic suggestions is problematic, especially when it comes to COPD patients belonging to Group A.
Conclusion
Our data provide valuable information regarding the demographic and medical profile of COPD patients in Greece, the domains which the revised ABCD assessment approach may show some clinical significance on, and the necessity for medical practitioners dealing with COPD patients to adhere closer to international recommendations for the proper management of the disease.
Snakes are integral components of ecosystems, being both predators and prey. They also provide valuable ecosystem services to people, such as rodent control, bushmeat, and leather goods. Although ...these positive services have been recognized, people are generally wary of snakes, because some species possess and release venom to immobilize prey. Therefore, understanding peoples' attitudes towards non-venomous and venomous snakes would be critical for their successful conservation. We carried out on-site face-to-face surveys with Greek residents (n = 897) to study their attitudes towards non-venomous and venomous snakes using a nine-statement attitudinal instrument. Survey participants had higher mutualism than domination wildlife value orientation and could more correctly identify the venomosity of venomous than non-venomous snake species. Factor analysis determined two general attitudes: tolerance and conservation. Participants were intolerant of snakes, while they generally supported their conservation, for both non-venomous and venomous species. However, their attitudes were more positive towards non-venomous than venomous snakes. Mutualism was a positive predictor of tolerance and conservation for non-venomous snakes, but only of conservation for venomous snakes. Domination was a negative predictor of conservation for both venomosity groups. Knowledge of snake venomosity was a positive predictor of tolerance and conservation for non-venomous snakes, and a negative predictor of tolerance for venomous snakes. Our findings not only indicated that the pubic differentiated attitudes towards snakes based on their venomosity but also, importantly, allowed for determining groups holding positive or negative attitudes towards snakes based on wildlife value orientations and the ability to evaluate snake venomosity. Such information further indicated that successful education and outreach plans should be venomosity and public group specific, aiming at increasing the pro-conservationist attitudes towards snakes, especially of those domination-oriented and unable to distinguish non-venomous from venomous snakes, thus promoting and ultimately securing the future survival of these controversial animals.
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•Tolerance and conservation attitudes were lower towards venomous snakes.•Mutualism was positively associated with attitudes for both venomosity groups.•Domination was negatively associated with conservation for both venomosity groups.•Venomosity knowledge positively predicted attitudes towards non-venomous snakes.•Venomosity knowledge negatively predicted tolerance of venomous snakes.
•A mean annual willingness to pay for snake conservation of €28.0 was estimated.•More participants considered snakes unattractive (55.1%) than attractive (26.5%).•More participants considered snakes ...fearsome (53.8%) than safe (28.8%).•Mutualism values and attractiveness were positively related to willingness to pay.•Young, rich, pet owners, females, and non-farmers reported high willingness to pay.
Snakes are at the same time valuable and vulnerable because they offer many ecosystem services but are also threatened by humans, both directly through persecution and indirectly through habitat destruction. The implicit human fear of snakes often leads to negative attitudes and behaviors. Increasing support and collecting funds are therefore critical for their future survival. We carried out face-to-face interviews of Greek residents (n = 936) for implementing a multiple-bounded discrete choice approach to estimate willingness to pay (WTP), the effects of cognitions, emotions, and sociodemographics on WTP and infer support for snake conservation. A mean annual WTP of €28.0 per household was estimated, suggesting that about €26.6 million per year could be collected during a fundraising campaign. Survey participants had higher mutualism than domination wildlife value orientations and reported moderately low levels of attractiveness and moderately high levels of fear toward snakes. Participants more mutualism-oriented who found snakes more attractive were WTP a higher amount for their conservation than those less mutualism-oriented who found snakes less attractive. Young, females, with higher income, non-farmers, and pet owners were WTP a higher amount for the conservation of snake species than old, males, with lower income, farmers, and non-pet owners. Findings revealed that considerable funds could be collected for snake conservation, further suggesting pro-conservation attitudes among the participants. Further, findings revealed groups with high and low WTP and support of the animals. This information would be valuable if used for creating and implementing tailored education and outreach programs aimed at increasing public support for the protection and survival of snake populations.
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