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Asthma in the Elderly: Can We Distinguish It from COPD?
Eleni G. Tzortzaki,Athanasia Proklou,Nikolaos M. Siafakas
Journal of Allergy , 2011, DOI: 10.1155/2011/843543
Abstract: Asthma in older adults affects quality of life and results in a higher hospitalization rate and mortality. In common clinical practice, asthma in the elderly is underdiagnosed and undertreated or overdiagnosed and mistreated. The age-related reduction in perception of shortness of breath and the high incidence of comorbidities make the diagnosis and management more difficult and challenging for the physicians. Chronic obstructive pulmonary disease (COPD) is usually easy to distinguish from asthma, but sometimes the distinction from late-onset asthma in older patients, particularly in cigarette smokers, is difficult and may be impossible. Both diseases are characterized by the presence of airflow obstruction but have distinct pathogenesis, inflammatory pattern, and prognosis. The distinction between Asthma and COPD based simply on spirometric parameters is difficult especially in the elderly asthmatics. The combination of lung function testing, bronchial hyperresponsiveness (BHR) and atopy status, HRCT scans, and the newly developed biological techniques, allowing the assessment of biomarker profiles, could facilitate the distinction between these diseases. 1. Introduction The increasing burden of obstructive lung diseases, such as Asthma and Chronic Obstructive Pulmonary Disease (COPD), appears to be caused, at least in part, by the ageing of the world’s population [1]. The World Health Organization estimates that between the years 2000 and 2050, the proportion of persons over 65 years of age is expected to represent up to 17% of the total world population [1]. In the case of asthma, the prevalence in the elderly is also high, affecting >10% of patients >60 years of age, while the estimated prevalence for COPD represents a 20% to 30% in patients >70 years of age [2, 3]. Although it was believed that asthma is predominantly a childhood disease [4, 5], asthma in the elderly is not a rare disorder [6]. Moreover, it is frequently underdiagnosed or misdiagnosed [4, 5] due to atypical presentation, age-related reduction of dyspnea perception, and associated comorbidities [6, 7]. In particular, Asthma and COPD may overlap and converge in older people [6, 8]. Ageing is associated with unique issues that modify expression, recognition, and treatment of the disease [6, 7]. Many older adults with asthma have a persistent airway obstruction on pulmonary function testing which makes it difficult to differentiate asthma from COPD [8–11]. Both diseases are associated with similar symptoms such as shortness of breath, wheezing, and coughing with or without sputum
Clinical, radiological and molecular effects in three patients with idiopathic pulmonary fibrosis after long-term treatment with interferon gamma-1b
Athanasia Proklou,Foteini Economidou,Katerina M. Antoniou,,Eleni G. Tzortzaki
Pneumon , 2009,
Sarcoidosis in a 65-year-old woman presenting with a lung mass and pericardial effusion: a case report
Margaritopoulos George A,Proklou Athanasia,Lagoudaki Eleni,Voloudaki Argiro
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-259
Abstract: Introduction Sarcoidosis is a multi-systemic disorder of unknown origin and most commonly affects the lungs. Diagnosis relies on the presence of non-caseating granulomas on histologic specimens. In high-resolution computed tomography, the most characteristic findings are peribronchovascular thickening, perilymphatic nodular distribution, and bilateral hilar adenopathy. Confluent nodular opacities or large masses are rare manifestations of the disease. It is well recognized that sarcoidosis can mimic infectious, malignant, and granulomatous conditions. Here, we report a case with a high initial index of suspicion for lung malignancy in terms of clinical, lung imaging, and endoscopic findings. Case presentation A 65-year-old Caucasian woman, lifelong non-smoker with an unremarkable medical history, presented with a 10-month history of progressive breathlessness, dry cough, fatigue, arthralgias, and mild weight loss. The only significant clinical finding was bilateral enlargement of auxiliary lymph nodes. High-resolution computed tomography revealed a soft tissue density mass at the right hilum which was surrounding and narrowing airways and vascular components, nodules with vascular distribution, enlarged mediastinal lymph nodes, and pericardial effusion. Our patient underwent a bronchoscopy, which revealed the presence of submucosal infiltration and narrowing of the right upper bronchus. Endobronchial biopsies showed non-caseating granulomas. As local sarcoid reactions with non-caseating granulomas can be observed near tumors, our patient underwent video-assisted thoracoscopy and surgical removal of an auxiliary lymph node, both of which confirmed the presence of non-caseating granulomas and the diagnosis of sarcoidosis. She was treated with steroids with improvement of clinical and imaging findings. However, while on a maintenance dose, she presented with a pleural effusion, which, after the diagnostic work-up, proved to be sarcoidosis-related. Treatment with initially high doses of steroids plus a steroid-sparing agent led to resolution of the effusion. Conclusions We report a case with a high initial index of suspicion for lung malignancy. Clinicians should always be aware that sarcoidosis enters the differential diagnosis of patients presenting with a lung mass that encases and narrows bronchial and vascular structures with associated pericardial effusion. Rarely, pleural effusion can be the presenting symptom of disease relapse despite maintenance treatment.
Different Activity of the Biological Axis VEGF-Flt-1 (fms-Like Tyrosine Kinase 1) and CXC Chemokines between Pulmonary Sarcoidosis and Idiopathic Pulmonary Fibrosis: A Bronchoalveolar Lavage Study
Katerina M. Antoniou,Giannoula Soufla,Athanasia Proklou,George Margaritopoulos,Christiana Choulaki,Rena Lymbouridou,Katerina D. Samara,Demetrios A. Spandidos,Nikolaos M. Siafakas
Clinical and Developmental Immunology , 2009, DOI: 10.1155/2009/537929
Abstract: Background. We have previously shown a different local and systemic angiogenic profile of CXC chemokines in Idiopathic Pulmonary Fibrosis (IPF) patients compared to sarcoidosis. In particular, sarcoidosis showed an angiostatic microenvironment, as compared with the angiogenic cytokine milieu seen in IPF. Purpose of the Study. Our aim was to further investigate the aforementioned finding by measuring the expression of different chemokines in granulomatous and fibrotic diseases. We estimated the levels of vascular endothelial growth factor (VEGF) and its high-affinity receptor, Flt-1 (fms-like tyrosine kinase 1), in bronchoalveolar lavage fluid (BALF) of patients with IPF and pulmonary sarcoidosis. We have also investigated the mRNA expression of angiogenetic chemokines' receptors such as CXCR2 and CXCR3 and the biological axis of stromal derived factor-1 (SDF-1 or CXCL12/CXCL12) and receptor, CXCR4. Methods. We studied prospectively three groups of patients: (i) one group of 18 patients with IPF, (ii) one group of 16 patients with sarcoidosis, and (iii) 10 normal subjects. Results. A statistically significant increase has been detected in VEGF mRNA expression in IPF in comparison with pulmonary sarcoidosis (=.03). In addition, a significant increase has been measured in CXCL12 in sarcoidosis in comparison to IPF (=.02). Moreover, a statistically significant decrease has been found in Flt-1 protein levels in pulmonary sarcoidosis in comparison with IPF (=.03). A significant increase in VEGF (=.03) and CXCR4 (=.03) mRNA levels has been also detected in sarcoidosis' patients when compared with healthy controls. Conclusions. Our data suggest that increased expression of Flt-1 and downregulation of CXCL12 in IPF may further support the hypothesis of a different angiogenetic profile between fibrotic and granulomatous diseases. However, further studies are needed in order to better investigate these enigmatic diseases.
Investigation of Telomerase/Telomeres system in Bone Marrow Mesenchymal Stem Cells derived from IPF and RA-UIP
Katerina M Antoniou, George A Margaritopoulos, Athanasia Proklou, Konstantinos Karagiannis, Ismini Lasithiotaki, Giannoula Soufla, Maria C Kastrinaki, Demetrios A Spandidos, Helen A Papadaki, Nikos M Siafakas:
Journal of Inflammation , 2012, DOI: 10.1186/1476-9255-9-27
Abstract: BM-MSCs were studied in 6 IPF patients, 7 patients with RA-UIP and 6 healthy controls. We evaluated the telomere length as well as the mRNA expression of both components of telomerase (human telomerase reverse transcriptase, h-TERT and RNA template complementary to the telomeric loss DNA, h-TERC).We found that BM-MSCs from IPF, RA-UIP cases do not present smaller telomere length than the controls (p?=?0.170). There was no significant difference regarding the expression of both h-TERT and h-TERC genes between patients and healthy controls (p?=?0.107 and p?=?0.634 respectively).We demonstrated same telomere length and telomerase expression in BM-MSCs of both IPF and RA-UIP which could explain similarities in pathogenesis and prognosis. Maintenance of telomere length in these cells could have future implication in cell replacement treatment with stem cells of these devastating lung disorders.
The Significance of Carbon 14 in Graphite Reactor Components at End of Generation  [PDF]
Martin Metcalfe, Athanasia Tzelepi
Journal of Environmental Protection (JEP) , 2019, DOI: 10.4236/jep.2019.102008
Abstract: It is estimated that there are at least 250,000 tonnes of irradiated graphite worldwide that will require eventual disposal. This graphite arises from a number of sources, but principally comprises moderator and structural materials for experimental reactors, production reactors, commercial power reactors and fuel assemblies. In the UK, a significant proportion of its irradiated graphite is classified as Intermediate Level Waste. Such waste is not heat generating but has a radioactive content exceeding 4 GBq per tonne alpha or 12 GBq per tonne beta/gamma activity. While the classification of waste is not consistent across states and proposals by individual states for the management of their graphite waste vary considerably, a common interest is the nature and distribution of its radioactive content. The radionuclides in irradiated graphite presenting the most significant long-term hazard are Carbon 14 (C-14) and Chlorine 36 (Cl-36) with half-lives of 5730 and 301,000 years respectively. For a better understanding of the way in which C-14 is produced, its distribution within irradiated graphite and realistic quantification of activity can potentially lead to improved characterization to validate its status within current or future waste classifications, segregation to reduce Intermediate Level Waste volumes, or treatment to reduce activity enabling re-classification as Low Level Waste. This paper reviews all these issues and then focuses on the significance of C-14. Some findings from a National Nuclear Laboratory study of C-14 levels in carbonaceous deposits and the underlying Magnox reactor graphite are presented to illustrate the need for thorough characterization of the waste material. These results are discussed in the context of aqueous leaching of C-14 from irradiated graphite and potential treatment options to minimize aqueous release. The paper concludes with some broader observations on the significance of C-14 in nuclear reactor graphite components and how these issues should be considered when preparing the lifetime management of new nuclear plant.
Social Entrepreneurship – Social Enterprises: European Experience and the Greek Case
Athanasia Triantafyllopoulou
Review of European Studies , 2012, DOI: 10.5539/res.v4n1p115
Abstract: In periods of recession, private sector of economy does not develop entrepreneurial action, due to limited demand which implies limited profits. This results in reduction in employment and increase in unemployment. Public sector of economy should proceed to public investments and enhance development. However, in the present economic crisis, public sector does not develop initiatives, due to budget deficit; to the contrary public sector is confined and contributes to the maintenance of recession. Social sector of economy does not aim at profit making but at job creation, mainly for the vulnerable groups of population. It intervenes by taking actions of mild economic growth and contributes to economic recovery. For this reason, national legislations in Europe provide the establishment of social economy enterprises. Local government, which, in a sense, belongs to the social sector of economy, has the possibilities to reinforce both social economy enterprises and actions of social entrepreneurship aiming for the enhancement of local economy.
A Novel Microstrip Antenna Array with Metamaterial-Based Electronic Beam Steering at 2.4 GHz
Athanasia Symeonidou;Katherine Siakavara
PIER C , 2013, DOI: 10.2528/PIERC13020405
Abstract: A metamaterial based electronically controlled microstrip structure, performing as leaky wave (LW) antenna with beam steering capability was synthesized. The structure has the configuration of metamaterial transmission line(TL) composed of cascade composite right- /left-handed(CRLH) unit cells. The direction of maximum radiation is tuned via the variation of varactros' capacities incorporated to the structure. Theoretical analysis and synthesis, based on the metamaterial TL theory, was made and novel methods to realize some of the elements of the units cells are proposed. Results, received via simulation, demonstrate that the LW antenna has steering capability of the direction of maximum radiation in a range of 40°, gain changing a little, 6 dB to 7 dB, during the scanning, whereas small number of cells is enough to obtain this performance.
The -female athlete triad-: Eating disorders - amenorrhea- osteoporosis
Maria Polikandrioti,Athanasia Tsami
To Vima tou Asklipiou , 2007,
Abstract: The female athlete triad is a syndrome which consists of eating disorders, amenorrhea and osteoporosis. The syndrome is increasing in prevalence over the last thirty years, as more women are participating in sports at a competitive level. The aim of the present study was to review the research data regarding the female athlete triad in order to underline the significance of the problem. The method οf this study included search of international medical and nursing literature data-bases, for the reason that the female athlete triad has been extensively studied after 1990. The results from the review of relevant studies showed that female athletes who follow hard preparative athletic programmes in which body weight is critical for success, often manifest eating disorder patterns. These lead to dysregulation of the hypothalamic-pituitarian-ovarian axis (HPO) and as a result to amenorrhea. Hypothalamic amenorrhea can lead to osteoporosis and increased fracture risk. Adolescents may particularly be at risk because it is during this crucial time that females attain their peak bone mass. Conclusively, a course of action that aims at preventing the occurrence of the syndrome is necessary. Prevention of the female athlete triad through education and identification of the athletes at risk may decrease the incidence of long-term catastrophic effects to health. Monitoring from a group of specialists should serve as a cornerstone when planning a program of training and preparation for high athletic performance
Equilibrium balking strategies for a clearing queueing system in alternating environment
Antonis Economou,Athanasia Manou
Mathematics , 2011,
Abstract: We consider a Markovian clearing queueing system, where the customers are accumulated according to a Poisson arrival process and the server removes all present customers at the completion epochs of exponential service cycles. This system may represent the visits of a transportation facility with unlimited capacity at a certain station. The system evolves in an alternating environment that influences the arrival and the service rates. We assume that the arriving customers decide whether to join the system or balk, based on a natural linear reward-cost structure. We study the balking behavior of the customers and derive the corresponding Nash equilibrium strategies under various levels of information.
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