Search PubMed⌕ Search

Biomedical subjects

Georgios Pappas

Publications and source records attributed to Georgios Pappas.

At least 19 recordsLinked to original sources
PubMed2006

Infection-related morbidity and mortality in patients with connective tissue diseases: a systematic review.

Patients suffering from connective tissue diseases (CTDs) constitute an important subgroup of immunosuppressed patients at risk for developing serious infections. Prophylactic antibiotic administration may decrease infection-related morbidity and mortality burden in patients with CTD, though one needs first to evaluate the overall effect of infection on morbidity and mortality in such patients and the presence of adequate prognostic/risk factors for infection development. Studies focusing on infection-related morbidity and mortality in patients with CTD were reviewed. Data on disease type, therapeutic regimens used, including corticosteroid dose and method of administration as well as other immunosuppressive agents, and outcome were extracted to evaluate the existence of specific treatment patterns predisposing to infection as well as infectious disease-related morbidity and mortality in patients with CTD. Thirty-nine studies focusing on infection incidence and/or outcome in patients with CTD were identified and analyzed; the majority of the reviewed studies (20) included patients with systemic lupus erythematosus (SLE). The mortality attributed to infection was 5.2%, while the overall mortality was 20%. There were no adequate data on the specific effect patterns of corticosteroid and immunosuppressant treatment on infection risk. Pneumocystis jiroveci (carinii) pneumonia, evaluated independently, exhibited significant mortality in patients with Wegener's granulomatosis, polymyositis/dermatomyositis, and SLE. In conclusion, infectious diseases are a major cause of mortality in patients with CTD. However, treatment-related factors predisposing to serious infections have not been adequately outlined. In addition, there are no data regarding the effect of prophylactic practices involving antibiotic administration in morbidity and mortality.

Connective Tissue Diseases↗
PubMed2006

World Wide Web hepatitis B virus resources.

BACKGROUND: Hepatitis B virus infection is a global public health issue, often under-discussed due to social prejudices related to its mode of transmission. The World Wide Web, an increasingly popular means of dissemination of health-related information, can serve continuing medical practitioner awareness and enhance public health literacy. OBJECTIVE: The authors sought to investigate the existence of, and evaluate the content of websites offering information on hepatitis B. STUDY DESIGN: Sites were selected by certain criteria (sponsor, language options, free access, validation of content by independent medical and non-medical personnel), which unavoidably rendered the lists subjective. RESULTS: At least three medical personnel-oriented websites (American Association for the Study of Liver Diseases, Clinical Care Options and The Hepatitis B Foundation sites) offer significant, up to date information on hepatitis B for clinicians. Sites offering information for the public used simple patterns as fact sheets and question-answer sets. The majority of the sites were based in the US. CONCLUSIONS: Hepatitis B virus infection is adequately represented in the web, regarding the needs of medical practitioners. Dissemination of information for the public appears in various modes, and at least at present, can only safely be achieved through simplified reports on the disease.

Hepatitis B↗
PubMed2006

Evidence of a genetic basis for the different geographic occurrences of liver/kidney microsomal antibody type 1 in hepatitis C.

Antibodies to liver/kidney microsome type 1 occur in Italian patients with hepatitis C, but rarely develop in North American patients. Our goals were to compare the frequencies of the HLA markers associated with autoimmune expression in Italian and North American patients with chronic hepatitis C and to determine genetic bases for regional differences in antibody production. HLA B8, DR3, DR4, DR7, DR11, DR13, DQ2, and the B8-DR3-DQ2 haplotype were determined by microlymphocytotoxicity and polymerase chain reaction in 105 Italian patients (50 with microsomal antibodies), 100 North American patients (none with microsomal antibodies), and Italian and North American healthy control subjects. Italian patients with microsomal antibodies differed from North American patients without these antibodies by having a higher frequency of HLA DR7 (54% vs. 27%, P=0.002). HLA DR7 occurred more frequently in seropositive Italian patients than in seronegative counterparts (54% vs. 11% P < 0.0001), Italian healthy control subjects (54% vs. 29%, P=0.0009), and North American healthy control subjects (54% vs. 19%, P < 0.0001). The frequency of HLA DR7 was similar in North American patients and controls (27% vs. 19%, P=0.2), but it was lower than in Italian controls (19% vs. 29%, P=0.059). Seropositive Italian patients had a lower frequency of HLA DR11 than seronegative Italian patients and Italian controls (18% vs. 34%, P=0.07, and 18% vs. 35%, P=0.02, respectively). In contrast to seropositive Italian patients, North American patients had HLA DR4 (30% vs. 12%, P=0.02), HLA DR13 (29% vs. 10%, P=0.01), and the B8-DR3-DQ2 haplotype (23% vs. 6%, P=0.01) more often. Similarly, HLA DR4 and the B8-DR3-DQ2 phenotype were more frequent in North American patients than in Italian controls (30% vs. 16%, P=0.005, and 23% vs. 7%, P=0.00002, respectively). HLA DR7 is associated with the development of microsomal antibodies in Italian patients with chronic hepatitis C. The lower frequency of HLA DR7 in North America could contribute to the rarity of these antibodies in this region. HLA DR11 may be protective against the development of microsomal antibodies in Italian patients, whereas HLA DR4, HLA DR13, and the B8-DR3-DQ2 haplotype may be protective in North American patients.

Adult↗
PubMed2006

Optimal treatment of leptospirosis: queries and projections.

Although the global burden of leptospirosis remains enormous and new aspects of the disease are constantly recognised, little progress has been achieved in the field of leptospirosis therapeutics and queries regarding the utility of antibiotics in the late severe form of the disease remain. From the currently existing data, conclusions on the efficacy of antibiotic administration in severe or late disease cannot easily be drawn, since clinical trials have different selection criteria and may focus on Leptospira serovars with different virulence. However, as a rule the benefit of the doubt should apply. Moreover, new options, such as ceftriaxone, have a superior safety profile to penicillin. In vitro studies have outlined potential antimicrobial candidates such as macrolides and ketolides. Development of a globally accepted subunit vaccine for humans is warranted but is not expected in the near future.

Animals↗
PubMed2006

Use of ceftriaxone in patients with severe leptospirosis.

The optimal treatment of severe and late leptospirosis, and even the need for antibiotic treatment in such clinical settings, remains a subject of debate. Twenty-two patients with severe late leptospirosis were treated with intravenous ceftriaxone 2g daily. Twenty-one patients recovered and one patient passed away due to respiratory complications of the disease. The adverse effect profile and the convenience of the regimen were superior to penicillin regimens reported in other clinical trials. Ceftriaxone may be a reasonable alternative in severe leptospirosis as an efficient, convenient and safe regimen. Large multicentre studies may further define the optimal interventions in severe leptospirosis as well as possible variations in the pathogenic and clinical parameters of respiratory leptospirosis.

Adult↗
PubMed2006

Health literacy in the field of infectious diseases: the paradigm of brucellosis.

OBJECTIVES: Treatment outcome for infectious diseases, including brucellosis, may be influenced by patient awareness of the disease itself, as well as by compounding socioeconomic factors. We attempted to evaluate parameters of patient awareness and disease perception in brucellosis and the ways they influence outcome. METHODS: We used a specifically developed questionnaire assessing various parameters of patient literacy on brucellosis in 70 patients with a new diagnosis of brucellosis. Patients were assessed by interviewing at the time of diagnosis and during follow-up. Awareness and perception of the disease, willingness for epidemiologic surveillance, mode of referral, treatment preferences, and adherence were evaluated. RESULTS: Although basic disease awareness is high, willingness to collaborate in epidemiologic surveillance is limited. Patient education may improve adherence to treatment and willingness to undergo surveillance, but may also result in many false referrals for relapse. Level of academic education does not influence the results. Convenience is the major factor when determining treatment preferences. CONCLUSION: Improving health literacy may result in improved treatment outcome and improved control of disease incidence. There is a need for constant evaluation of the quality and quantity of information distributed in order to reduce transmission of misinformation and occurrences of public anxiety.

Brucellosis↗
PubMed2006

The new global map of human brucellosis.

The epidemiology of human brucellosis, the commonest zoonotic infection worldwide, has drastically changed over the past decade because of various sanitary, socioeconomic, and political reasons, together with the evolution of international travel. Several areas traditionally considered to be endemic--eg, France, Israel, and most of Latin America--have achieved control of the disease. On the other hand, new foci of human brucellosis have emerged, particularly in central Asia, while the situation in certain countries of the Near East (eg, Syria) is rapidly worsening. Furthermore, the disease is still present, in varying trends, both in European countries and in the USA. Awareness of this new global map of human brucellosis will allow for proper interventions from international public-health organisations.

Animals↗
PubMed2006

Jaundice of unknown origin: Remember zoonoses!

Zoonotic diseases are randomly remembered in the differential diagnosis of jaundice of unknown origin. We present four characteristic cases of jaundice attributed to brucellosis and Coxiella burnetii infection and discuss the various pathogenetic pathways implicated in each case. We present a brief review of the relevant literature and, in an era of increasing subspecialization, underline the importance of viewing the "whole picture".

Aged↗
PubMed2006

Pseudomonas fluorescens infections in clinical practice.

Pseudomonas fluorescens was isolated from an elderly immunocompromized patient with fever. Treatment with ceftazidime was successful, after empirical therapy failed. Pseudomonas fluorescens is 1 of the less virulent members of the Pseudomonadaceae family. The epidemiology of the infection and the difficulties in isolation and susceptibility assessment are further discussed.

Aged, 80 and over↗
PubMed2006

Future trends in human brucellosis treatment.

The global burden of human brucellosis remains enormous. Existing treatment options, largely based on experience gained > 30 years ago, are adequate but not optimal. The evolving understanding of the pathophysiology of the disease may augment in designing and evaluating alternative approaches that may prove to be superior. Current alternative approaches such as co-trimoxazole-containing regimens, should be widely evaluated as being more cost-effective. New methods of delivery such as gentamicin-loaded microparticles, neutralisation of the environment where Brucella resides and use of novel antibiotics such as tigecycline may be of importance in the future. The role of immunomodulation, widely but inconsistently applied in 'chronic' brucellosis, should be further evaluated in all disease stages to define if it is of any use. The development of a subcellular vaccine would be an important step forward although one has to take into account the multiple interactions between Brucella and the immune system, various technical problems and the lack of funds. Reviewing existing attempts at the development of such a vaccine, the authors conclude that a trivalent subcellular vaccine may be needed for adequate efficacy.

Anti-Bacterial Agents↗
PubMed2005

Brucellosis.

Explore the source record for details and available documents.

Antibodies, Bacterial↗
PubMed2005

Genetic distinctions between autoimmune hepatitis in Italy and North America.

AIM: Our goals were to analyze the known genetic predispositions for autoimmune hepatitis (AIH) in AIH Italian population and to compare them with North American counterparts. METHODS: Human leukocyte antigens (HLA) B8, C7, DR3, DR4, DR7, DR11, DR13, DQ2 and the B8-DR3-DQ2 phenotype were determined by microlymphocytotoxicity and polymerase chain reaction in 74 Italian patients (57 with type 1 and 17 with type 2 AIH) and 149 North American patients with type 1 AIH, and in adequate controls. RESULTS: B8-DR3-DQ2 occurred more frequently in Italian patients with type 1 AIH than in Italian controls (30% vs 7%, P<0.0001), but less frequently than in North American counterparts (30% vs 48%, P = 0.02). DR4 occurred less frequently in Italian patients with type 1 AIH (23% vs 43%, P = 0.01) and in controls (16% vs 34%, P = 0.0003) than in North American counterparts. No differences were found in alleles' frequency between type 1 and type 2 Italian AIH patients. DR11 had a frequency lower in type 1 Italian AIH patients than controls (17% vs 35%, P = 0.01). CONCLUSION: HLA DR4 is not associated with AIH in Italy. The known HLA risk factors for AIH occur similarly in Italian patients with type 1 and type 2 AIH, and they are less frequent than in North American patients. B8-DR3-DQ2 is the predominant phenotype of type 1 AIH also in Italy, and HLA DR11 may be a regionally distinctive protective factor against type 1 AIH.

Adolescent↗
PubMed2005

New approaches to the antibiotic treatment of brucellosis.

The global burden of human brucellosis remains enormous, yet its optimal treatment remains based on traditional combinations of doxycycline with either rifampicin or streptomycin. Of the currently existing alternative regimens, only the combination of doxycycline with gentamicin can be considered therapeutically adequate and cost effective, the latter factor being a major obstacle in the utilisation of quinolones for brucellosis. Newer antibiotics, most notably tigecycline, may help in achieving monotherapy or shorter treatment duration. Alternatively, modification of the acidic intracellular environment where Brucellae reside may allow for enhanced effectiveness of existing antibiotics.

Anti-Bacterial Agents↗
PubMed2005

Effective treatments in the management of brucellosis.

Treatment of uncomplicated brucellosis in humans utilises a variety of anti-biotic combinations, applied to a series of important pathogenetic and clinical parameters. The currently recommended treatment regimens have not been surpassed by newer compounds, and various therapeutic strategies utilising these compounds cannot be adequately evaluated due to the absence of large, multi-centre, multinational trials. The review focuses on the basic principles of brucellosis treatment, the properties of the various regimens used, the results of trials involving them, and the questions raised about the efficacy of these regimens in certain clinical situations.

Anti-Bacterial Agents↗
PubMed2005

[Significance of non-organ-specific autoantibodies in HCV-related chronic hepatitis].

The preliminary question regarding the clinical issue of the antiviral therapy in the HCV related chronic hepatitis patients is: is it mandatory the research for the autoantibodies in the eligible patients for the antiviral treatment? This issue is of particular interest at the light of the the reported cases of HCV positive patients with positivity for liver kidney microsome type 1 antibody who developed a hepatitic flare during the antiviral treatment. The data from literature about the efficacy and safety on the antiviral treatment in patients with autoantibodies are few and controversial, particularly if the ones regarding antiviral drugs and more recent treatment regimens are taking into account (peg-interferon, combined therapy of interferon and ribavirin). Large and prospective studies are needed for a thorough evaluation about the potential impact of autoantibodies reactivity on the therapeutic outcome. To date, it must be confirmed that a strict monitoring of hepatic parameters is to recommend during the whole treatment phase. This in the light of a potential appearance of significant flares of aminotransferases, particularly in subjects with anti LKM-1 autoantibodies, during interferon therapy.

Antiviral Agents↗