Pioglitazone and asthma: a review of current evidence.

OBJECTIVE: This review aims to present existing evidence on the impact of pioglitazone, a thiazolidinedione class anti-diabetic drug, on asthma control and lung function, providing a comprehensive understanding of its potential as a treatment for asthma. DATA SOURCES: The review draws upon data from preclinical animal studies and clinical trials investigating the effects of pioglitazone on asthma, focusing on its role in reducing airway inflammation, hyperreactivity, and remodeling, and its impact on pulmonary function. STUDY SELECTIONS: Relevant studies were selected based on their examination of pioglitazone's therapeutic effects in asthma, including both animal models and clinical trials involving human asthma patients. RESULTS: Animal studies have suggested that pioglitazone could alleviate inflammation, airway hyperreactivity, and airway remodeling, thereby improving pulmonary function in asthma. However, clinical trials have not demonstrated significant therapeutic benefits, with minimal improvements observed in asthma control and lung function, and the presence of notable side effects. CONCLUSION: Despite promising preclinical data, the efficacy of pioglitazone in treating human asthma remains unproven, with safety concerns and limited clinical benefits observed in trials. Further research is needed to assess the safety and effectiveness of pioglitazone in asthma treatment and to explore its impact on other inflammatory mechanisms.

Psychopathology in asthma patients: analysis of demographic and clinical associations.

BACKGROUND: Asthma, a chronic inflammatory condition affecting the airways, significantly impacts both respiratory function and quality of life. Recent studies have highlighted the psychological dimensions of chronic diseases like asthma. Despite growing evidence linking asthma with various psychopathological conditions, comprehensive data remains scarce. AIM: This study aims to explore the psychopathological status of asthma patients and identify demographic and clinical factors associated with higher levels of psychopathological symptoms. METHODS: Data were collected from 42 asthma patients attending the Asthma Outpatient Clinic at the University of Thessaly, Greece. Participants completed a detailed questionnaire on demographics and clinical parameters, along with the Symptoms Checklist-90 (SCL-90) to assess psychological symptoms. RESULTS: The sample included patients with varying asthma severity: 38% with severe asthma and 62% with mild-moderate asthma, with a mean age of 60.8 ± 15.6 years. Results indicated that 23.8% exhibited somatization symptoms, 23.8% showed compulsive behaviors, 33.8% reported interpersonal sensitivity, and 38.1% experienced depression and 38.1% aggressiveness. Additionally, 45.2% struggled with fearful anxiety, 4.8% showed paranoid ideation, and 11.9% had traits of psychoticism. Women had significantly higher psychopathology scores than men. Factors such as longer disease duration, uncontrolled asthma, severe asthma, and comorbid conditions like atopy and gastroesophageal reflux disease (GERD) were linked to higher psychopathological scores. CONCLUSIONS: The study found a high prevalence of psychopathological symptoms among asthma patients. Female gender, prolonged asthma duration, persistent symptoms, comorbid diseases (GERD, atopy) and greater disease severity were significantly associated with higher psychopathology, underscoring the need for integrated mental health care in asthma management.

Lung cancer in patients with idiopathic pulmonary fibrosis: A retrospective multicentre study in Europe.

BACKGROUND AND OBJECTIVE: There remains a paucity of large databases for patients with idiopathic pulmonary fibrosis (IPF) and lung cancer. We aimed to create a European registry. METHODS: This was a multicentre, retrospective study across seven European countries between 1 January 2010 and 18 May 2021. RESULTS: We identified 324 patients with lung cancer among 3178 patients with IPF (prevalence = 10.2%). By the end of the 10 year-period following IPF diagnosis, 26.6% of alive patients with IPF had been diagnosed with lung cancer. Patients with IPF and lung cancer experienced increased risk of all-cause mortality than IPF patients without lung cancer (HR: 1.51, [95% CI: 1.22-1.86], p < 0.0001). All-cause mortality was significantly lower for patients with IPF and lung cancer with a monocyte count of either <0.60 or 0.60-<0.95 K/µl than patients with monocyte count ≥0.95 K/µl (HR [<0.60 vs. ≥0.95 K/µl]: 0.35, [95% CI: 0.17-0.72], HR [0.60-<0.95 vs. ≥0.95 K/µl]: 0.42, [95% CI: 0.21-0.82], p = 0.003). Patients with IPF and lung cancer that received antifibrotics presented with decreased all cause-mortality compared to those who did not receive antifibrotics (HR: 0.61, [95% CI: 0.42-0.87], p = 0.006). In the adjusted model, a significantly lower proportion of surgically treated patients with IPF and otherwise technically operable lung cancer experienced all-cause mortality compared to non-surgically treated patients (HR: 0.30 [95% CI: 0.11-0.86], p = 0.02). CONCLUSION: Lung cancer exerts a dramatic impact on patients with IPF. A consensus statement for the management of patients with IPF and lung cancer is sorely needed.

Changes in Smoking Habits in Greece During the Lockdown Measures Due to COVID-19.

INTRODUCTION: During lockdown, people are experiencing higher than usual levels of stress related to social isolation, employment, and finances that may result in lifestyle changes. Here, we aim to assess whether smoking habits changed during the lockdown measures due to coronavirus disease 2019 (COVID-19). METHODS: For the purpose of the survey, an online questionnaire was distributed from the tenth of April to the second of May 2020, among a Greek population, by using an online platform. RESULTS: Two hundred smokers/vapers participated in the present survey (62.5% women, 44% of 36-45 years, 29% of 16-55 years, 15.5% 26-35 years). The daily number of cigarettes smoked before the onset of the COVID-19 pandemic is 15.06 ± 9.84, while during the restrictive measures due to COVID-19, the daily number of cigarettes smoked is 14.52 ± 10.13 (p > 0.05). Vapers consumed an average of 0.54 ± 2.43 mL vapor per day before the COVID-19 pandemic and 0.61 ± 2.81 mL during lockdown. Males smoked more cigarettes per day before (16.31 ± 11.87) and during the lockdown (15.33 ± 12.17) versus females (14.30 ± 8.36) and 14.04 ± 8.70, respectively) (p > 0.05 for both genders). Before versus during the restrictive measures, subjects that were primary school graduates smoked more cigarettes per day (28.00 ± 9.09 and 27.50 ± 9.57, respectively), followed by subjects that were high school graduates (16.90 ± 9.33 and 15.97 ± 9.50, respectively), university graduates (14.17 ± 10.14 and 13.93 ± 10.66, respectively), postgraduates (12.96 ± 9.52 and 12.25 ± 9.90, respectively) and middle school graduates (12.89 ± 8.22 and 14.22 ± 7.93, respectively).The self-reported reason for the change in the mL vaporized and the cigarettes smoked are confinement at home (36.3%), stress about COVID-19 (34.09%), free time (20.45%), boredom (4.54%), stress about the work status (2.27%), and participation in online lucky games (2.27%). DISCUSSION: We did not observe significant differences in the daily consumption of smoke/vaping during the lockdown measures. More studies are needed to assess the long-term effects of the pandemic in smoking habits.

Neck mass and bilateral pleural effusions in a 53-year-old female.

Chylothorax indicates the accumulation of chyle in the pleural cavity. It is a rare cause of pleural effusion, especially bilaterally. In clinical practice, the presence of milky fluid in the pleural cavity raises the suspicion of chylothorax. The most common cause is trauma, iatrogenic or non, owing to thoracic duct injury, which transports chyle from the lymphatic system into the bloodstream. The case we describe is of a 53-year-old female who was referred to our hospital with bilateral pleural effusions and a left supraclavicular mass. From the diagnostic studies, the nontraumatic causes of chylothorax were excluded. The potential diagnosis was traumatic chylothorax, a diagnosis of exclusion, as it appeared after muscle stretch and receded with a fat-free diet and repose without any relapse.

Serum lactate dehydrogenase and its isoenzymes as predictors of clinical outcomes in acute exacerbation of chronic obstructive pulmonary disease: a retrospective analysis of a hospitalized cohort.

We aimed to test the association between serum lactate dehydrogenase (LDH) and its isoenzymes and treatment outcomes during hospitalization for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Thirty-eight AECOPD patients were recruited from a tertiary hospital from December 2017 to June 2018. Serum LDH and LDH isoenzymes were measured on venous blood collected at admission. Treatment outcomes included duration of hospital stay, initiation of non-invasive (NIV) or mechanical ventilation, initiation of antipseudomonal antibiotics, change in empirical antibiotic treatment, need for intravenous corticosteroids or methylxanthines, and percentage of change in C-reactive protein from admission to the third day. Multivariate linear and binary logistic regression analyses were used to test the study's objectives. We found that, after adjusting for age, gender, comorbidities, COPD severity, level of hypoxemia, and inflammation markers, each 10 U/L increase in serum LDH was associated with prolongation of the hospital stay by 0.25 (0.03, 0.46) days, 42% higher odds (odds ratio [OR] 1.42 [1.00, 2.03]) for need of NIV, and 25% higher odds (OR 1.25 [1.04, 1.49]) for initiation of antipseudomonal treatment. LDH1 and LDH2 were the LDH isoenzymes that mainly drove these relationships. LDH release in the context of an AECOPD could originate from lung, muscle, or heart tissue damage due to airway inflammation, respiratory muscle recruitment, and myocardial stress. Myocardial injury and aerobic adaptation in respiratory muscles may explain the predominance of LDH1 and LDH2 isoenzymes in these associations.

Genotype-Phenotype Relationships in Inheritable Idiopathic Pulmonary Fibrosis: A Greek National Cohort Study.

BACKGROUND: Monogenic and polygenic inheritances are evidenced for idiopathic pulmonary fibrosis (IPF). Pathogenic variations in surfactant protein-related genes, telomere-related genes (TRGs), and a single-nucleotide polymorphism in the promoter of MUC5B gene encoding mucin 5B (rs35705950 T risk allele) are reported. This French-Greek collaborative study, Gen-Phen-Re-GreekS in inheritable IPF (iIPF), aimed to investigate genetic components and patients' characteristics in the Greek national IPF cohort with suspected heritability. PATIENTS AND METHODS: 150 patients with familial PF, personal-family extrapulmonary disease suggesting short telomere syndrome, and/or young age IPF were analyzed. RESULTS: MUC5B rs35705950 T risk allele was detected in 103 patients (90 heterozygous, 13 homozygous, allelic frequency of 39%), monoallelic TRG pathogenic variations in 19 patients (8 TERT, 5 TERC, 2 RTEL1, 2 PARN, 1 NOP10, and 1 NHP2), and biallelic ABCA3 pathogenic variations in 3. Overlapping MUC5B rs35705950 T risk allele and TRG pathogenic variations were shown in 11 patients (5 TERT, 3 TERC, 1 PARN, 1 NOP10, and 1 NHP2), MUC5B rs35705950 T risk allele, and biallelic ABCA3 pathogenic variations in 2. In 38 patients, neither MUC5B rs35705950 T risk allele nor TRG pathogenic variations were detectable. Kaplan-Meier curves showed differences in time-to-death (p = 0.025) where patients with MUC5B rs35705950 T risk allele alone or in combination with TRG pathogenic variations presented better prognosis. CONCLUSION: The Gen-Phen-Re-GreekS in iIPF identified multiple and overlapping genetic components including the rarest, underlying disease's genetic "richesse," complexity and heterogeneity. Time-to-death differences may relate to diverse IPF pathogenetic mechanisms implicating "personalized" medical care driven by genotypes in the near future.

Increased monocyte count and red cell distribution width as prognostic biomarkers in patients with Idiopathic Pulmonary Fibrosis.

BACKGROUND: Idiopathic Pulmonary Fibrosis (IPF) represents a chronic lung disease with unpredictable course. METHODS: We aimed to investigate prognostic performance of complete blood count parameters in IPF. Treatment-naïve patients with IPF were retrospectively enrolled from two independent cohorts (derivation and validation) and split into subgroups (high and low) based on median baseline monocyte count and red cell distribution width (RDW). RESULTS: Overall, 489 patients (derivation cohort: 300, validation cohort: 189) were analyzed. In the derivation cohort, patients with monocyte count ≥ 0.60 K/µL had significantly lower median FVC%pred [75.0, (95% CI 71.3-76.7) vs. 80.9, (95% CI 77.5-83.1), (P = 0.01)] and DLCO%pred [47.5, (95% CI 44.3-52.3) vs. 53.0, (95% CI 48.0-56.7), (P = 0.02)] than patients with monocyte count < 0.60 K/µL. Patients with RDW ≥ 14.1% had significantly lower median FVC%pred [75.5, (95% CI 71.2-79.2) vs. 78.3, (95% CI 76.0-81.0), (P = 0.04)] and DLCO%pred [45.4, (95% CI 43.3-50.5) vs. 53.0, (95% CI 50.8-56.8), (P = 0.008)] than patients with RDW < 14.1%. Cut-off thresholds from the derivation cohort were applied to the validation cohort with similar discriminatory value, as indicated by significant differences in median DLCO%pred between patients with high vs. low monocyte count [37.8, (95% CI 35.5-41.1) vs. 45.5, (95% CI 41.9-49.4), (P < 0.001)] and RDW [37.9, (95% CI 33.4-40.7) vs. 44.4, (95% CI 41.5-48.9), (P < 0.001)]. Patients with high monocyte count and RDW of the validation cohort exhibited a trend towards lower median FVC%pred (P = 0.09) and significantly lower median FVC%pred (P = 0.001), respectively. Kaplan-Meier analysis in the derivation cohort demonstrated higher all-cause mortality in patients with high (≥ 0.60 K/µL) vs. low monocyte count (< 0.60 K/µL) [HR 2.05, (95% CI 1.19-3.53), (P = 0.01)]. CONCLUSIONS: Increased monocyte count and RDW may represent negative prognostic biomarkers in patients with IPF.

The role of antimicrobial resistance on long-term mortality and quality of life in critically ill patients: a prospective longitudinal 2-year study.

BACKGROUND: In the recent era, antimicrobial resistance has been identified as one of the most important threats to human health worldwide. The rapid emergence of antibiotic-resistant pathogens (ABRP) in the modern intensive care unit (ICU) also represents a "nightmare scenario" with unknown clinical consequences. In the Greek ICU, in particular, gram negative ABRPs are now considered endemic. However, the possible longitudinal impact of ABRPs on long-term outcomes of ICU patients has not yet been determined. METHODS: In this two-year (January 2014-December 2015) single-centre observational longitudinal study, 351 non-neurocritical ICU patients ≥ 18 year-old were enrolled. Patients' demographic, clinical and outcome data were prospectively collected. Quality-adjusted life years (QALY) were calculated at 6, 12, 18 and 24 months after ICU admission. RESULTS: Fifty-eight patients developed infections due to ABRP (ABRP group), 57 due to non-ABRP (non-ABRP group), and 236 demonstrated no infection (no-infection group) while in ICU. Multiple regression analysis revealed that multiple organ dysfunction syndrome score (OR: 0.676, 95%CI 0.584-0.782; P < 0.001) and continuous renal replacement therapy (OR: 4.453, 95%CI 1.805-10.982; P = 0.001) were the only independent determinants for ABRP infections in ICU. Intra-ICU, 90-day and 2-year mortality was 27.9%, 52.4% and 61.5%, respectively. Compared to the non-ABRP and no-infection group, the ABRP group demonstrated increased intra-ICU, 90-day and 2-year mortality (P ≤ 0.022), worse 2-year survival rates in ICU patients overall and ICU survivor subset (Log-rank test, P ≤ 0.046), and poorer progress over time in 2-year QALY kinetics in ICU population overall, ICU survivor and 2-year survivor subgroups (P ≤ 0.013). ABRP group was further divided into multi-drug and extensively-drug resistant subgroups [MDR (n = 34) / XDR (n = 24), respectively]. Compared to MDR subgroup, the XDR subgroup demonstrated increased ICU, 90-day and 2-year mortality (P ≤ 0.031), but similar 90-day and 2-year QALYs (P ≥ 0.549). ABRP infections overall (HR = 1.778, 95% CI 1.166-2.711; P = 0.008), as well as XDR [HR = 1.889, 95% CI 1.075-3.320; P = 0.027) but not MDR pathogens, were independently associated with 2-year mortality, after adjusting for several covariates of critical illness. CONCLUSIONS: The present study may suggest a significant association between ABRP (especially XDR) infections in ICU and increased mortality and inability rates for a prolonged period post-discharge that requires further attention in larger-scale studies.

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

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.

Reduction in Hospitalizations for Respiratory Diseases during the First COVID-19 Wave in Greece.

INTRODUCTION: During the first COVID-19 wave, a considerable decline in hospital admissions was observed worldwide. AIM: This retrospective cohort study aimed to assess if there were any changes in the number of patients hospitalized for respiratory diseases in Greece during the first CO-VID-19 wave. METHODS: In the present study, we evaluated respiratory disease hospitalization rates across 9 tertiary hospitals in Greece during the study period (March-April 2020) and the corresponding period of the 2 previous years (2018-2019) that served as the control periods. Demographic data and discharge diagnosis were documented for every patient. RESULTS: Of the 1,307 patients who were hospitalized during the study period, 444 (35.5%) were males with a mean (±SD) age of 66.1 ± 16.6 years. There was a 47 and 46% reduction in all-cause respiratory morbidity compared to the corresponding periods of 2018 and 2019, respectively. The mean incidence rate for respiratory diseases during the study period was 21.4 admissions per day, and this rate was significantly lower than the rate during the same period in 2018 (40.8 admissions per day; incidence rate ratio [IRR], 0.525; 95% confidence interval [CI], 0.491-0.562; p < 0.001) or the rate during 2019 (39.9 admissions per day; IRR, 0.537; 95% CI, 0.502-0.574; p < 0.001). The greatest reductions (%) in the number of daily admissions in 2020 were observed for sleep apnoea (87% vs. 2018 and 84% vs. 2019) followed by admissions for asthma (76% vs. 2018 and 79% vs. 2019) and chronic obstructive pulmonary disease (60% vs. 2018 and 51% vs. 2019), while the lowest reductions were detected in hospitalizations for pulmonary embolism (6% vs. 2018 and 23% vs. 2019) followed by tuberculosis (25% vs. both 2018 and 2019). DISCUSSION/CONCLUSION: The significant reduction in respiratory admissions in 2020 raises the reasonable question of whether some patients may have avoided seeking medical attention during the COVID-19 pandemic and suggests an urgent need for transformation of healthcare systems during the pandemic to offer appropriate management of respiratory diseases other than COVID-19.

Temporal trends in pulmonary embolism prevalence in Greece during 2013-2017.

BACKGROUND: Pulmonary embolism (PE) epidemiological data about the disease prevalence in the general population are unclear. The present study aims to investigate the prevalence of PE in Greece and the associated temporal trends for the years 2013-2017. METHODS: Data on medical prescriptions for PE in the years 2013-2017 were provided by the Greek National Health Service Organization (EOPYY). Data on age, gender, specialty of the prescribing physician and prescription unit were provided as well. RESULTS: The total number of medical prescriptions for PE for the study period was 101,426. Of the total prescriptions, 51% were issued by the Public Sector and 48% by the Private Sector. In 2013 the prevalence of PE was 5.43 cases per 100,000 citizens and increased constantly until 2017 with 23.79 cases per 100,000 population. Prevalence was higher in all years studied in the age group of 70-80 years. For the year 2017, we observed 69.35 cases per 100,000 population for subjects 70-80 years, followed by the ages 80-90 (60.58/100,000) and 60-70 years (56.47 /100,000). Females displayed higher PE prevalence than males and higher increasing trend. CONCLUSION: PE prevalence has an increasing trend throughout the years 2013-2017 while prevalence in females is higher than males and displays a higher increasing trend. Our results may be used to appropriately organize nationwide health care campaigns aiming at the diagnosis, treatment and prevention of PE.

Exhaled Nitric Oxide (FeNO) in Patients Hospitalized for an Exacerbation of Bronchiectasis and/or COPD : FeNO Levels in COPD and Bronchiectasis.

Exhaled nitric oxide (FeNO) represents an important marker of airway inflammation, yet its role in chronic obstructive pulmonary disease (COPD) and/or bronchiectasis is not well studied. We aimed to measure FeNO in patients with COPD, bronchiectasis, and combination of COPD/bronchiectasis during an acute exacerbation (AE) of the underlying disease as well as to describe the characteristics of patients with COPD/bronchiectasis overlap in patients hospitalized for an acute exacerbation (AE). Seventy-nine patients were enrolled in the study as follows: COPD n = 45, bronchiectasis n = 18, and COPD and bronchiectasis n = 16. FeNO was measured with a commercially available analyzer within 24 hours of admission and at discharge. FeNO differed significantly on admission when compared at discharge in the whole group (16.91 ± 16.14 vs 12.48 ± 10.67, p = 0.008, respectively). On admission, FeNO was 17.80 ± 18.77 ppb in COPD patients, 17.12 ± 6.59 in bronchiectasis patients, and 11.55 ± 2.42 in patients with COPD/bronchiectasis overlap. At discharge, FeNO was 12.40 ± 12.11 ppb in COPD patients, 15.50 ± 6.39 in bronchiectasis patients, and 9.00 ± 3.22 in patients with combination. FeNO differed significantly in bronchiectasis patients versus patients with COPD/bronchiectasis overlap at admission (p = 0.043) and at discharge (p = 0.020) and versus COPD patients at discharge (p = 0.043). FeNO decreased significantly during the AE in all groups (p = 0.001 for COPD, p = 0.021 for bronchiectasis, and p = 0.026 for combination). FeNO levels in patients with COPD and/or bronchiectasis exacerbation are possibly increased at admission and decrease at discharge. The differences in FeNO levels between groups may reflect different underlying inflammatory mechanisms.

Compliance of Bronchial Asthma Patients' with the Mediterranean Diet : Compliance with the Mediterranean Diet in Asthma Patients.

INTRODUCTION: Asthma is considered the most common chronic disease that affects survival and quality of life. An astringent regulatory factor of asthma is the Mediterranean diet. Nutrition, however, seems to be of great importance in the onset and outcome of the disease as many ingredients and eating habits that may improve or exacerbate the condition of the patient. PURPOSE: The present study aimed to investigate dietary habits in patients with bronchial asthma and their compliance with the Mediterranean diet. MATERIAL AND METHODS: The study included 60 patients with bronchial asthma, 47 women (71% of the total) and 17 men (28.3%). All patients completed a questionnaire with sociodemographic questions, a medical history (years of diagnosis, exacerbations, hospitalizations, medication), and spirometry results (FEV1, FVC, FEV1/FVC, PEF, FEF25-75). Asthma control was evaluated with the Asthma Control Test (ACT). Conformity to the Mediterranean diet was assessed using the MEDLIFE index (Mediterranean lifestyle) questionnaire. Statistical analysis of the data was done using the SPSS 23.0 statistical package by applying the Inductive Analysis, which included the Pearson correlation coefficient (r), the t-test for independent samples, and the variance analysis (one-way ANOVA). RESULTS: There was a significant negative correlation of last year hospitalizations with the MEDLIFE questionnaire scale (r = -0.522, p = 0.009) and a significant negative correlation of last year's exacerbations with the ACT scale. We observed a significant negative correlation of hospitalizations in the last year with the ACT scale (r = -0.505, p = 0.012) and a significant statistical relationship of long acting ß2 agonist + steroid with the MEDLIFE scale (p = 0.046). CONCLUSION: The level of compliance with the principles of the Mediterranean diet leads to a reduction in hospitalization. The optimal asthma control is associated with a reduction of exacerbations and asthma control is associated with reduced hospitalizations. Those receiving beta2 + steroid show higher levels of compliance with the principles of the Mediterranean diet.

Lung cancer in patients with Idiopathic Pulmonary Fibrosis. A retrospective multicenter study in Greece.

BACKGROUND: Abundant evidence supports an association between Idiopathic Pulmonary Fibrosis (IPF) and lung cancer development. Data on diagnosis and management of patients with IPF and lung cancer are still scarce. PATIENTS AND METHODS: This was a retrospective multicenter study, enrolling 1016 patients with IPF from eight different centers between 2011 and 2018 in Greece. Our aim was to estimate prevalence of lung cancer in patients with IPF in Greece. RESULTS: We identified 102 cases of patients with IPF and lung cancer (prevalence = 10.03% n = 102/1016, mean age±SD = 71.8 ± 6.9, 96 males, mean FVC±SD = 72.7 ± 19.7, mean DLCO±SD = 44.5 ± 16.3). We identified 85 cases (83.3%) of non-small cell lung cancer (35 squamous, 28 adenocarcinoma), and 15 cases (14.7%) of small cell lung cancer. Primary lesion was localized in lower lobes in 57.1% of cases. Lung cancer was diagnosed post IPF diagnosis (mean latency time + SD = 33.2 + 36.1 months) in 57.6% of patients and synchronously in 36.5% of patients. Chemotherapy was applied in 26.7% of cases, while 34.7% of patients underwent surgery. Median survival of patients with IPF and lung cancer was 27.4 months (95% CI: 20.6 to 36.8). CONCLUSIONS: IPF is a risk factor for lung cancer development. In line with current literature, squamous cell carcinoma is the most common histologic subtype in patients with IPF. Large randomized controlled studies on the management of patients with IPF and lung cancer are sorely needed.

Time trends for pulmonary embolism incidence in Greece.

BACKGROUND: Pulmonary embolism (PE) is a disease with a significant impact on public health. However, international epidemiological data are unclear and show considerable heterogeneity. The present study aims to investigate the incidence of PE at the Greek population and the associated demographic characteristics of patients with PE. METHODS: Data on hospital admissions for PE between 1999 and 2012 were provided by the Hellenic Statistical Authority of Greece. Data on age, gender and days of hospitalization from 1999 to 2007 were provided as well. The total population in each region was derived from the 1991, 2001, 2011 Census of the national statistical service of Greece. RESULTS: The mean annual incidence of PE during the study period was 18.5 per 100.000 population. The annual incidence of PE showed an upward trend ranging from 14 (1999) to 30 (2012) per 100.000 population. In the years before and after the economic crisis faced by Greece we observed statistically significant differences of PE incidence for the two different periods (1999-2008 versus 2009-2012, 14.49 versus 23.06 respectively, p = 0.002). The available data revealed a female predominance (16.48 cases for females per 100.000 population versus 13.69 cases for males per 100.000 population, p = 0.031). Incidence rate increased with age with a higher incidence in the "80-89" age group. CONCLUSIONS: The incidence of PE appeared to increase in Greece, while it remains below the expected trend in an international context that may be attributed to Computed Tomography Pulmonary Angiography availability and/or PE awareness among clinicians.

Malignant mesothelioma cells secrete natriuretic peptides: Data and diagnostic clinical implications.

BACKGROUND AND OBJECTIVE: Mesothelial cells and cardiomyocytes have shared embryonic mesodermal origin. Cardiomyocytes release BNP under stretch. We searched whether malignant mesothelioma cells also secrete BNP and if so, this has a meaningful impact. METHODS: Part I: Prospectively, patients with pleural lesions on CT having malignant mesothelioma effusions (MME, n = 13) were compared to patients with malignant effusions with pleural lesions (MEa, n = 14). Age-matched patients with ME without pleural lesions (MEb, n = 16) and non-malignant effusions (NME, n = 25) were analysed. Part II: Retrospectively, samples from patients with mesothelioma (n = 14), lung cancer (n = 8) or heart failure (n = 9) were used. BNP was measured in pleural fluid and blood/plasma. Part III: BNP was assessed in the culture supernatants of benign (MeT-5A) and malignant mesothelioma cell lines (M14K-epithelioid, MSTO-biphasic and ZL34-sarcomatoid) (n = 10 per cell line in three different biological replicates). RESULTS: In vitro, BNP concentration was significantly higher in the supernatant of all malignant cell lines than benign ones (P < 0.01), denoting BNP's production from the former. The pleural fluid to blood BNP ratio in MME was extremely high in Part I and Part II subjects (28.3 ± 12.1 and 25.9 ± 8.6, respectively) versus 1.1 ± 0.3 and 0.4 ± 0.1 in Part I ME and NME, respectively (P < 0.0001), and 0.8 ± 0.1 and 0.4 ± 0.1 in Part II ME and NME, respectively (P < 0.0001). BNP ratio ≥2.11 in Part I had 92% sensitivity and 94.5% specificity for MME (P < 0.0001). CONCLUSION: BNP is secreted from malignant mesothelial cells. In clinical practice, the pleural fluid to blood BNP ratio can help in the diagnosis of malignant mesothelioma.

Concurrent cardiac sarcoidosis and obstructive sleep apnea presenting as arrhythmias.

BACKGROUND: Cardiac involvement is a rare and potentially fatal presentation of sarcoidosis. Obstructive sleep apnea may complicate sarcoidosis. CASE PRESENTATION: We report a case of a sarcoidosis patient with cardiac involvement presenting with ventricular arrhythmias. Besides medical and invasive measures of therapy, the patient failed to respond fully. The patient was subjected to overnight polysomnography and diagnosed with concurrent obstructive sleep apnea syndrome. Following continuous positive airway pressure therapy, we observed a significant improvement of ventricular arrhythmias while methylprednisolone was further tapered. CONCLUSIONS: To our knowledge, this is the first report of cardiac sarcoidosis further implicated by OSAHS and presenting as ventricular arrhythmias that underlies the need for extensive testing in cardiac sarcoidosis in patients not responding to immunosuppressive therapy.

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

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 (FEV1), forced vital capacity (FVC), and FEV1/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.

Design, Rationale, Methodology, and Aims of a Greek Prospective Idiopathic Pulmonary Fibrosis Registry: Investigating Idiopathic Pulmonary Fibrosis in Greece (INDULGE IPF).

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a chronic, fibrosing interstitial pneumonia of unknown origin. Despite the fact that the guidelines on the diagnosis and management of the disease were updated in 2015, incorporating novel agents recently introduced in the therapeutic approach of IPF, there is a lack of data on the epidemiology, disease status, and treatment in clinical practice. Contemporary data provided by national registries in IPF provide valuable information to guide clinical management of the disease in the real-world setting, adjusted to the local needs. OBJECTIVE: Investigating Idiopathic Pulmonary Fibrosis in Greece (INDULGE IPF) is a Greek observational registry aiming at gaining further knowledge on the characteristics, management, progression, and outcomes of patients with IPF treated under real-world, clinical practice conditions in Greece. METHODS: Approximately 300 patients will be enrolled consecutively in seven reference centers, constituting the largest IPF registry ever established in Greece. CONCLUSION: This registry is expected to provide data on the characteristics of IPF patients in Greece and the entire clinical management during the course of the disease.