Publications by authors named "Charikleia Vrettou"

is notorious for its ability to spread within healthcare environments, particularly in intensive care units (ICUs), posing significant challenges for clinicians as treatment options become limited. This is especially concerning in the context of central nervous system (CNS)-invasive infections. While rare, its involvement in nosocomial brain ventriculitis presents substantial diagnostic and therapeutic challenges, with no established guidelines for managing CNS infections caused by .

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Post-intensive care syndrome (PICS) encompasses persistent physical, psychological, and cognitive impairments. The coronavirus disease of 2019 (COVID-19) pandemic highlighted parallels between PICS and "long COVID". There is an overlap between the 2 in risk factors, symptoms, and pathophysiology.

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Article Synopsis
  • Critically ill patients in the ICU are often immobilized and on mechanical ventilation, increasing their risk for thromboembolic diseases like deep vein thrombosis (DVT) and pulmonary embolism (PE).
  • Managing DVT and PE in the ICU is different from doing so in the emergency department, as existing guidelines mainly focus on emergency settings and don't account for the complexities of critically ill patients.
  • This review seeks to summarize data and provide practical recommendations for the prevention, diagnosis, and treatment of PE specifically in ICU patients.
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Endothelin-1 (ET-1) is a potent vasoconstrictor produced by endothelial cells and cleared from circulating blood mainly in the pulmonary vasculature. In a healthy pulmonary circulation, the rate of local production of ET-1 is less than its rate of clearance. In the present study, we aimed to investigate whether the abnormal pulmonary circulatory handling of ET-1 relates to poor clinical outcomes in patients with coronavirus disease 2019 (COVID-19)-induced acute respiratory distress syndrome (ARDS).

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  • Severe traumatic brain injury (sTBI) is a significant health issue, leading to around 300,000 ICU admissions each year and having a 30% mortality rate, which highlights the need for improved management despite low treatment evidence.
  • The occurrence of pulmonary embolism (PE) in sTBI patients complicates treatment due to the risks associated with anticoagulating an already injured brain.
  • A literature review was conducted, analyzing recent studies on sTBI and PE, resulting in 38 relevant papers that discuss the prevalence, risk factors, diagnostic challenges, prophylaxis timing, and treatment options for PE in these patients.
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  • - The study examined serum levels of GFAP, s100b, and total Tau in long-COVID patients to investigate links to symptoms, cognitive decline, mental health issues, and quality of life.
  • - It included 65 long-COVID patients and 20 controls, finding that GFAP levels were higher in patients but didn’t correlate with long-COVID symptoms; other biomarkers like s100b and total Tau showed no significant difference.
  • - The research highlighted high rates of cognitive decline (65.9%), depression (32.2%), anxiety (47.5%), and PTSD (44.1%) among long-COVID patients, with most participants scoring below normal on quality of life assessments.
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Unlabelled: Early initiation of antimicrobial therapy targeting resistant bacterial pathogens causing sepsis and bloodstream infections (BSIs) is critical for a successful outcome. The T2Resistance Panel (T2R) detects the following resistance genes within organisms that commonly cause BSIs directly from patient blood samples: , , , , , , , and A/C. We conducted a prospective study in two major medical centers for the detection of circulating resistance genes by T2R in patients with BSIs.

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Pupillometry, an integral component of neurological examination, serves to evaluate both pupil size and reactivity. The conventional manual assessment exhibits inherent limitations, thereby necessitating the development of portable automated infrared pupillometers (PAIPs). Leveraging infrared technology, these devices provide an objective assessment, proving valuable in the context of brain injury for the detection of neuro-worsening and the facilitation of patient monitoring.

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Objective: To investigate hormonal status in patients with long-COVID and explore the interrelationship between hormone levels and long-COVID symptoms.

Design: Prospective observational study.

Participants: Patients who visited our long-COVID outpatients' clinic due to long-COVID symptoms from February 2021 to December 2022.

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Since the beginning of the pandemic, both COVID-19-associated coagulopathy biomarkers and a plethora of endothelial biomarkers have been proposed and tested as prognostic tools of severity and mortality prediction. As the pandemic is gradually being controlled, attention is now focusing on the long-term sequelae of COVID-19. In the present study, we investigated the role of endothelial activation/dysfunction in long COVID syndrome.

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Article Synopsis
  • - Sepsis leads to abnormal cortisol levels due to initial increased secretion from adrenal glands, followed by a decline as adrenal function worsens; this results in relative adrenal insufficiency.
  • - The dysregulation of cortisol impacts the body's inflammatory response, raising interest in corticosteroids as a potential treatment, though results from clinical trials have been inconsistent.
  • - The review will cover cortisol changes in critically ill sepsis patients, including COVID-19 cases, and discuss the implications for corticosteroid use in treating both COVID-19 and non-COVID-19 associated sepsis.
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The pulmonary endothelium is a highly regulated organ that performs a wide range of functions under physiological and pathological conditions. Since endothelial dysfunction has been demonstrated to play a direct role in sepsis and acute respiratory distress syndrome, its role in COVID-19 has also been extensively investigated. Indeed, apart from the COVID-19-associated coagulopathy biomarkers, new biomarkers were recognised early during the pandemic, including markers of endothelial cell activation or injury.

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Background : COVID-19 disease severity markers include mostly molecules related to not only tissue perfusion, inflammation, and thrombosis, but also biomarkers of neural injury. Clinical and basic research has demonstrated that SARS-COV-2 affects the central nervous system. The aims of the present study were to investigate the role of neural injury biomarkers and to compare them with inflammatory markers in their predictive ability of mortality.

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Introduction: Post intensive care syndrome (PICS) affects an increasing number of critical illness survivors and their families, with serious physical and psychological sequelae. Since little is known about the burden of critical illness on ICU survivor families, we conducted a prospective observational study aiming to assess this, and investigate correlations of the patients' psychometric and health-related quality of life (HRQOL) scores with family burden.

Materials And Methods: Twenty-nine patients were evaluated in the presence of a family member.

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Study Objective: Despite the almost universal administration of supplemental oxygen in patients presenting in the emergency department (ED) with severe traumatic brain injury, optimal early oxygenation levels are unknown. Therefore, we aimed to examine the effect of different early oxygenation levels on the clinical outcomes of patients presenting in the emergency department with severe traumatic brain injury.

Methods: We performed a secondary analysis of the Resuscitation Outcomes Consortium Traumatic Brain Injury Hypertonic Saline randomized controlled trial by including patients with Glasgow Coma Scale ≤8.

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Acute respiratory distress syndrome (ARDS) is a heterogeneous syndrome historically characterized by the presence of severe hypoxemia, high-permeability pulmonary edema manifesting as diffuse alveolar infiltrate on chest radiograph, and reduced compliance of the integrated respiratory system as a result of widespread compressive atelectasis and fluid-filled alveoli. Coronavirus disease 19 (COVID-19)-associated ARDS (C-ARDS) is a novel etiology caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that may present with distinct clinical features as a result of the viral pathobiology unique to SARS-CoV-2. In particular, severe injury to the pulmonary vascular endothelium, accompanied by the presence of diffuse microthrombi in the pulmonary microcirculation, can lead to a clinical presentation in which the severity of impaired gas exchange becomes uncoupled from lung capacity and respiratory mechanics.

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Intracranial hypertension is a common finding in patients with severe traumatic brain injury. These patients need treatment in the intensive care unit, where intracranial pressure monitoring and, whenever possible, multimodal neuromonitoring can be applied. A three-tier approach is suggested in current recommendations, in which higher-tier therapies have more significant side effects.

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Aim: Postresuscitation hemodynamics are associated with hospital mortality/functional outcome. We sought to determine whether low-dose steroids started during and continued after cardiopulmonary resuscitation (CPR) affect postresuscitation hemodynamics and other physiological variables in vasopressor-requiring, in-hospital cardiac arrest.

Methods: We conducted a two-center, randomized, double-blind trial of patients with adrenaline (epinephrine)-requiring cardiac arrest.

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Article Synopsis
  • Recent studies have focused on the soluble urokinase plasminogen activator receptor (suPAR) as a potential biomarker for diagnosing and predicting mortality in ICU patients with infections.
  • In this research, suPAR levels were measured in both COVID-19 and non-COVID-19 septic patients, revealing higher levels in COVID-19 cases upon admission.
  • While suPAR has been shown to be an effective mortality risk predictor for COVID-19 patients, it did not provide useful prognostic information for non-COVID-19 septic patients when measured at sepsis diagnosis.
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A limited number of coronavirus disease-19 (COVID-19) cases may require treatment in an intensive care unit (ICU). Arterial blood lactate levels are routinely measured in the ICU to estimate disease severity, predict poor outcomes, and monitor therapeutic handlings. A number of studies have suggested that, simultaneously with lactate, pyruvate should also be measured, providing augmented prognostic ability, and a better understanding of the underlying metabolic alterations in ICU patients.

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Traumatic brain injury (TBI) is the leading cause of mortality and disability among trauma-related injuries. Neuromonitoring plays an essential role in the management and prognosis of patients with severe TBI. Our bibliometric study aimed to identify the knowledge base, define the research front, and outline the social networks on neuromonitoring in severe TBI.

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Current achievements in medical science and technological advancements in intensive care medicine have allowed better support of critically ill patients in intensive care units (ICUs) and have increased survival probability. Post-intensive care syndrome (PICS) is a relatively new term introduced almost 10 years ago, defined as "new or worsening impairments in physical, cognitive, or mental health status arising after critical illness and persisting beyond acute care hospitalization". A significant percentage of critically ill patients suffer from PICS for a prolonged period of time, with physical problems being the most common.

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  • - The study investigates the relationship between immunoglobulin (Ig) levels and clinical outcomes in COVID-19 patients, focusing specifically on IgG, IgM, and IgA levels at hospital admission.
  • - Results show that patients who survived had significantly higher IgG levels compared to those who did not survive, indicating a link between low IgG levels and higher mortality.
  • - The findings suggest that low IgG levels upon admission may independently predict a higher risk of death in COVID-19 patients.
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