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Search Results: 1 - 10 of 1345 matches for " Nikolaos Papanas "
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Charcot osteoarthropathy in diabetes: A brief review with an emphasis on clinical practice
Evanthia Gouveri,Nikolaos Papanas
World Journal of Diabetes , 2011, DOI: 10.4239/wjd.v2.i5.59
Abstract: Charcot osteoarthropathy (COA) is a potentially limbthreatening condition that mainly affects diabetic patients with neuropathy. In everyday practice, it presents as a red, hot, swollen foot, usually painless, and is frequently triggered by trivial injury. Its etiology is traditionally attributed to impairment of either the autonomic nervous system, leading to increased blood flow and bone resorption, or of the peripheral nervous system, whereby loss of pain and protective sensation render the foot susceptible to repeated injury. More recently, excessive local inflammation is thought to play a decisive role. Diagnosis is based on clinical manifestation and imaging studies (plain X-rays, bone scan, Magnetic Resonance Imaging). The mainstay of management is immediate off-loading, while surgery is usually reserved for chronic cases with irreversible deformities and/or joint instability. The aim of this review is to provide an overview of COA in terms of pathogenesis, classification and clinical presentation, diagnosis and treatment, with an emphasis on the high suspicion required by clinicians for timely recognition to avoid further complications.
Antidiabetic treatment: Though lovers be lost, love shall not
Nikolaos Papanas,Efstratios Maltezos
World Journal of Diabetes , 2012, DOI: 10.4239/wjd.v3.i9.158
Abstract: The new position statement of the American Diabetes Association and the European Association for the Study of Diabetes on the management of type 2 diabetes mellitus represents a paradigm shift in our understanding of antidiabetic treatment. It emphasises the necessity to individualise management based on patient needs. Glycaemic targets should also be pursued on an individualised basis. New therapeutic combinations are discussed, and the uncertainty surrounding the ideal choice is acknowledged. Above all, it is the mindful and experienced clinician who will implement the best available evidence towards flexible and efficacious treatment. Some areas of uncertainty may ensue, but it is expected that the new position statement will improve patient healthcare and treatment satisfaction. This now remains to be seen in practice.
Continuous positive airway pressure to improve insulin resistance and glucose homeostasis in sleep apnea
Paschalis Steiropoulos,Nikolaos Papanas
World Journal of Diabetes , 2011,
Abstract: Obstructive sleep apnea syndrome (OSAS) is a relatively common disorder in the adult population. It is associated with alterations in glucose metabolism and increases the risk for diabetes mellitus. Continuous positive airway pressure (CPAP) is the treatment of choice for OSAS. It may also have a favorable effect on insulin resistance and glucose metabolism, although relevant data is conflicting. Additional research is still needed to fully establish the effect of CPAP on glucose homeostasis. It should ascertain which patients may benefit most and how long treatment takes to induce favorable changes. Finally, patient compliance is being appreciated as a major factor influencing therapeutic outcomes, and this needs to be further examined.
Becaplermin gel in the treatment of diabetic neuropathic foot ulcers
Nikolaos Papanas,Efstratios Maltezos
Clinical Interventions in Aging , 2008,
Abstract: Nikolaos Papanas, Efstratios MaltezosOutpatient Clinic of Obesity, Diabetes and Metabolism at the Second Department of Internal Medicine, Democritus University of Thrace, GreeceAbstract: Diabetic foot ulcers remain a major cause of morbidity. Significant progress has been accomplished in ulcer healing by improved management of both ischemia and neuropathy in the diabetic foot. Nevertheless, there is a vital need for further improvement. Becaplermin gel represents an important therapeutic advance for diabetic neuropathic foot ulcers with adequate blood supply. Randomized controlled trials have shown that it is effective in increasing healing rates. However, this efficacy has not translated to positive clinical experience, and the drug is not widely used. Moreover, becaplermin is an expensive medication. Even though it has repeatedly been estimated as cost-effective, its high cost may be prohibitive for some clinicians, especially in developing countries. Clearly, further work is needed to clarify whether use of becaplermin is justified in everyday clinical practice. Future research also needs to assess the potential room for improvement with becaplermin, for instance by combination with other growth factors or by exploring alternative modes of drug delivery.Keywords: becaplermin, diabetes mellitus, diabetic foot, neuropathy, PDGF
A fairy tale of modern insulin therapy in type 1 diabetes
Nikolaos Papanas,Maria Demetriou,Efstratios Maltezos
World Journal of Diabetes , 2010,
Abstract: In type 1 diabetes, flexible, intensive insulin management improves not only glycemic control but also dietary freedom and treatment satisfaction. Such flexibility has been made possible with the new insulin analogues (as part of a basal-bolus regime) and is now gaining wide applicability, especially among children and adolescents. This approach requires appropriate individualized patient education. Especially for adolescents, the clinician should be able to guarantee insightful participation in direct response to their attitudes, wishes and needs. This patient-and-doctor collaboration is an ever-challenging duty and has the potential to change the future of the individual diabetic patient.
A giant adrenal lipoma presenting in a woman with chronic mild postprandial abdominal pain: a case report
Stylianos Kapetanakis, Ioannis Drygiannakis, Anastasios Tzortzinis, Nikolaos Papanas, Aliki Fiska
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-136
Abstract: A 54-year-old Caucasian woman presented several times over a period of 10 years to various emergency departments complaining of long-term mild postprandial abdominal pain. Although clinical examinations were unrevealing, an abdominal computed tomography scan performed at her most recent presentation led to the identification of a large lipoma of the left adrenal gland, which occupied most of the retroperitoneal space. Myelolipoma was ruled out due to the absence of megakaryocytes, immature leukocytes, or erythrocytes. Liposarcoma was ruled out due to the absence of lipoblasts. The size of the lipoma (16 × 14 × 7 cm) is, to the best of our knowledge, the second largest reported to date. After surgical resection, our patient was relieved of her symptoms and remains healthy six years postoperatively.Physicians should be aware that differential diagnosis of mild chronic abdominal pain in patients presenting in emergency rooms may include large adrenal lipomas. When initial diagnostic investigation is not revealing, out-patient specialist evaluation should be planned to enable appropriate further investigations.Adenomas, pheochromocytomas, and adrenocortical carcinomas represent the most common tumors of the adrenal glands [1]. In contrast, lipomatous tumors are rare, comprising 4.8% of all primary adrenal tumors and include myelolipomas, lipomas, angiomyolipomas, and liposarcomas [2,3], myelolipomas being the most common [4]. Adrenal lipomas are uncommon. However, the widespread use of ultrasound and computed tomography (CT) has led to their being increasingly discovered as incidental findings during routine examination. Their overall incidence on autopsy is 6% and 4% in imaging studies [5]. Their frequency tends to increase with age.A total of 18 cases have been reported since 1966, as summarized in Table 1[2-4,6-14]. In all, 58% were asymptomatic or were found post-mortem [3,6,8,10,11]. However, there are case reports of adrenal lipomas presenting either with acute ab
HbA1c is associated with severity of obstructive sleep apnea hypopnea syndrome in nondiabetic men
Nikolaos Papanas, Paschalis Steiropoulos, Evangelia Nena, et al
Vascular Health and Risk Management , 2009, DOI: http://dx.doi.org/10.2147/VHRM.S7057
Abstract: A1c is associated with severity of obstructive sleep apnea hypopnea syndrome in nondiabetic men Short Report (4190) Total Article Views Authors: Nikolaos Papanas, Paschalis Steiropoulos, Evangelia Nena, et al Published Date September 2009 Volume 2009:5 Pages 751 - 756 DOI: http://dx.doi.org/10.2147/VHRM.S7057 Nikolaos Papanas1, Paschalis Steiropoulos2, Evangelia Nena2, Argyris Tzouvelekis2, Efstratios Maltezos1, Georgia Trakada2, Demosthenes Bouros2 1Outpatient Clinic of Obesity, Diabetes and Metabolism at the 2nd Department of Internal Medicine, 2Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece Abstract: The aim of this study was to examine the potential correlation of sleep characteristics with glucose metabolism in nondiabetic men with obstructive sleep apnea syndrome (OSAS). Included were 31 male patients (mean age 46.7 ± 11 years), recently diagnosed with OSAS by full polysomnography. There was a significant correlation of fasting glucose and glycosylated hemoglobin (HbA1c) levels with arousal index (P = 0.047 and P = 0.014, respectively). Moreover, HbA1c levels were correlated with apnea hypopnea index (P = 0.009), a widely accepted marker of the severity of OSAS, and with percentage of sleep time with saturation of hemoglobin with oxygen as measured by pulse oximetry (SpO2) <90% (t < 90%) (P = 0.010). Finally, glucose and HbA1c levels showed a significant negative correlation with average SpO2 (P = 0.013 and P = 0.012, respectively) and, additionally, glucose levels with minimum SpO2 (P = 0.027) during sleep. In conclusion, severity of OSAS among nondiabetic men is associated with increased HbA1c levels and increased fasting glucose. Thus, severity of OSAS may be an additional marker of cardiovascular risk, as well as of future diabetes, in these subjects. However, further work is needed to confirm the clinical significance of these observations.
Predictors of obstructive sleep apnea in males with metabolic syndrome
Nikolaos Papanas, Paschalis Steiropoulos, Evangelia Nena, et al
Vascular Health and Risk Management , 2010, DOI: http://dx.doi.org/10.2147/VHRM.S7948
Abstract: edictors of obstructive sleep apnea in males with metabolic syndrome Original Research (3928) Total Article Views Authors: Nikolaos Papanas, Paschalis Steiropoulos, Evangelia Nena, et al Published Date April 2010 Volume 2010:6 Pages 281 - 286 DOI: http://dx.doi.org/10.2147/VHRM.S7948 Nikolaos Papanas1, Paschalis Steiropoulos2, Evangelia Nena2, Argyris Tzouvelekis2, Athanasios Skarlatos2, Maria Konsta2, Vasileios Vasdekis3, Efstratios Maltezos1, Demosthenes Bouros2 1Outpatient Clinic of Obesity, Diabetes and Metabolism, Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece; 2Sleep Laboratory, Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece; 3Department of Statistics, Athens University of Economic and Business, Athens, Greece Abstract: The aim of the present study was to examine the prevalence of metabolic syndrome (MS) and its components among obstructive sleep apnea (OSA) patients vs controls, as well as to investigate which of these components are strongly associated with the presence of OSA in subjects reporting symptoms indicating sleep-disordered breathing. Included were 83 consecutive male subjects, without known concomitant diseases, who visited an outpatient clinic of obesity, diabetes and metabolism. Based on polysomnography, these were divided into two groups: OSA patients (n = 53) and controls (n = 30). Parameters indicating MS, according to the NCEP ATP III criteria (blood pressure, waist circumference, glucose, triglycerides, and HDL-cholesterol levels) were evaluated in both groups. The criteria for MS were fulfilled in 49 participants. Presence of MS was significantly correlated with the presence of OSA. However, after adjustment for BMI, only serum glucose was significantly associated with the presence of OSA (P = 0.002). Conversely, the presence of MS was associated with a significant reduction in percentage of slow-wave sleep (P = 0.030). In conclusion, these results provide further evidence for the association between OSA and MS. Between subjects with MS, elevated serum glucose levels indicate a higher probability for the presence of OSA.
HbA1c is associated with severity of obstructive sleep apnea hypopnea syndrome in nondiabetic men
Nikolaos Papanas,Paschalis Steiropoulos,Evangelia Nena,et al
Vascular Health and Risk Management , 2009,
Abstract: Nikolaos Papanas1, Paschalis Steiropoulos2, Evangelia Nena2, Argyris Tzouvelekis2, Efstratios Maltezos1, Georgia Trakada2, Demosthenes Bouros21Outpatient Clinic of Obesity, Diabetes and Metabolism at the 2nd Department of Internal Medicine, 2Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, GreeceAbstract: The aim of this study was to examine the potential correlation of sleep characteristics with glucose metabolism in nondiabetic men with obstructive sleep apnea syndrome (OSAS). Included were 31 male patients (mean age 46.7 ± 11 years), recently diagnosed with OSAS by full polysomnography. There was a significant correlation of fasting glucose and glycosylated hemoglobin (HbA1c) levels with arousal index (P = 0.047 and P = 0.014, respectively). Moreover, HbA1c levels were correlated with apnea hypopnea index (P = 0.009), a widely accepted marker of the severity of OSAS, and with percentage of sleep time with saturation of hemoglobin with oxygen as measured by pulse oximetry (SpO2) <90% (t < 90%) (P = 0.010). Finally, glucose and HbA1c levels showed a significant negative correlation with average SpO2 (P = 0.013 and P = 0.012, respectively) and, additionally, glucose levels with minimum SpO2 (P = 0.027) during sleep. In conclusion, severity of OSAS among nondiabetic men is associated with increased HbA1c levels and increased fasting glucose. Thus, severity of OSAS may be an additional marker of cardiovascular risk, as well as of future diabetes, in these subjects. However, further work is needed to confirm the clinical significance of these observations.Keywords: obstructive sleep apnea syndrome, glucose metabolism, glycated hemoglobin, sleep disordered breathing
Predictors of obstructive sleep apnea in males with metabolic syndrome
Nikolaos Papanas,Paschalis Steiropoulos,Evangelia Nena,et al
Vascular Health and Risk Management , 2010,
Abstract: Nikolaos Papanas1, Paschalis Steiropoulos2, Evangelia Nena2, Argyris Tzouvelekis2, Athanasios Skarlatos2, Maria Konsta2, Vasileios Vasdekis3, Efstratios Maltezos1, Demosthenes Bouros21Outpatient Clinic of Obesity, Diabetes and Metabolism, Second Department of Internal Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece; 2Sleep Laboratory, Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece; 3Department of Statistics, Athens University of Economic and Business, Athens, GreeceAbstract: The aim of the present study was to examine the prevalence of metabolic syndrome (MS) and its components among obstructive sleep apnea (OSA) patients vs controls, as well as to investigate which of these components are strongly associated with the presence of OSA in subjects reporting symptoms indicating sleep-disordered breathing. Included were 83 consecutive male subjects, without known concomitant diseases, who visited an outpatient clinic of obesity, diabetes and metabolism. Based on polysomnography, these were divided into two groups: OSA patients (n = 53) and controls (n = 30). Parameters indicating MS, according to the NCEP ATP III criteria (blood pressure, waist circumference, glucose, triglycerides, and HDL-cholesterol levels) were evaluated in both groups. The criteria for MS were fulfilled in 49 participants. Presence of MS was significantly correlated with the presence of OSA. However, after adjustment for BMI, only serum glucose was significantly associated with the presence of OSA (P = 0.002). Conversely, the presence of MS was associated with a significant reduction in percentage of slow-wave sleep (P = 0.030). In conclusion, these results provide further evidence for the association between OSA and MS. Between subjects with MS, elevated serum glucose levels indicate a higher probability for the presence of OSA. Keywords: diabetes mellitus, glucose, metabolic syndrome, obstructive sleep apnea
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