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  1. Article: A step-by-step guide for the diagnosis and management of hyponatraemia in patients with stroke.

    Barkas, Fotios / Anastasiou, Georgia / Liamis, George / Milionis, Haralampos

    Therapeutic advances in endocrinology and metabolism

    2023  Volume 14, Page(s) 20420188231163806

    Abstract: Hyponatraemia is common in patients with stroke and associated with adverse outcomes and increased mortality risk. The present review presents the underlying causes and provides a thorough algorithm for the diagnosis and management of hyponatraemia in ... ...

    Abstract Hyponatraemia is common in patients with stroke and associated with adverse outcomes and increased mortality risk. The present review presents the underlying causes and provides a thorough algorithm for the diagnosis and management of hyponatraemia in stroke patients. Concomitant diseases and therapies, such as diabetes, chronic kidney disease and heart failure, along with diuretics, antidepressants and proton pump inhibitors are the most common causes of hyponatraemia in community. In the setting of acute stroke, the emergence of hyponatraemia might be attributed to the administration of hypotonic solutions and drugs (ie. mannitol and antiepileptics), poor solute intake, infections, as well as stroke-related conditions or complications, such as the syndrome of inappropriate secretion of antidiuretic hormone, cerebral salt wasting syndrome and secondary adrenal insufficiency. Diagnostically, the initial step is to differentiate hypotonic from non-hypotonic hyponatraemia, usually caused by hyperglycaemia or recent mannitol administration in patients with stroke. Determining urine osmolality, urine sodium level and volume status are the following steps in the differentiation of hypotonic hyponatraemia. Of note, specific parameters, such as fractional uric acid and urea excretion, along with plasma copeptin concentration, may further improve the diagnostic yield. Therapeutic options are based on the duration and symptoms of hyponatremia. In the case of acute or symptomatic hyponatraemia, hypertonic saline administration is recommended. Hypovolaemic chronic hyponatremia is treated with isotonic solution administration. Although fluid restriction remains the first-line treatment for the rest forms of chronic hyponatraemia, therapies increasing renal free water excretion may be necessary. Loop diuretics and urea serve this purpose in patients with stroke, whereas sodium-glucose transport protein-2 inhibitors appear to be a promising therapy. Nevertheless, it is yet unclear whether the appropriate restoration of sodium level improves outcomes in such patients. Randomized trials designed to compare therapeutic strategies in managing hyponatraemia in patients with stroke are required.
    Language English
    Publishing date 2023-04-03
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2554822-0
    ISSN 2042-0196 ; 2042-0188
    ISSN (online) 2042-0196
    ISSN 2042-0188
    DOI 10.1177/20420188231163806
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Early Investigational and Experimental Therapeutics for the Treatment of Hypertriglyceridemia.

    Parthymos, Ioannis / Kostapanos, Michael S / Liamis, George / Florentin, Matilda

    Journal of cardiovascular development and disease

    2022  Volume 9, Issue 2

    Abstract: Hypertriglyceridemia has been identified as a risk factor for cardiovascular disease and acute pancreatitis. To date, there are only few drug classes targeting triglyceride levels such as fibrates and ω-3 fatty acids. These agents are at times ... ...

    Abstract Hypertriglyceridemia has been identified as a risk factor for cardiovascular disease and acute pancreatitis. To date, there are only few drug classes targeting triglyceride levels such as fibrates and ω-3 fatty acids. These agents are at times insufficient to address very high triglycerides and the residual cardiovascular risk in patients with mixed dyslipidemia. To address this unmet clinical need, novel triglyceride-lowering agents have been in different phases of early clinical development. In this review, the latest and experimental therapies for the management of hypertriglyceridemia are presented. Specifically, ongoing trials evaluating novel apolipoprotein C-III inhibitors, ω-3 fatty acids, as well as fibroblast growth 21 analogues are discussed.
    Language English
    Publishing date 2022-01-25
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2777082-5
    ISSN 2308-3425 ; 2308-3425
    ISSN (online) 2308-3425
    ISSN 2308-3425
    DOI 10.3390/jcdd9020042
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Association of Alkaline Phosphatase with Cardiovascular Disease in Patients with Dyslipidemia: A 6-Year Retrospective Study.

    Adamidis, Petros Spyridonas / Florentin, Matilda / Liberopoulos, Evangelos / Koutsogianni, Amalia Despoina / Anastasiou, Georgia / Liamis, George / Milionis, Haralampos / Barkas, Fotios

    Journal of cardiovascular development and disease

    2024  Volume 11, Issue 2

    Abstract: Background and aim: Serum alkaline phosphatase (ALP) activity has been associated with atherosclerotic cardiovascular disease (ASCVD). We aimed to investigate the association of ALP with ASCVD in patients with dyslipidemia.: Methods: We conducted a ... ...

    Abstract Background and aim: Serum alkaline phosphatase (ALP) activity has been associated with atherosclerotic cardiovascular disease (ASCVD). We aimed to investigate the association of ALP with ASCVD in patients with dyslipidemia.
    Methods: We conducted a retrospective cohort study including consecutive adults with dyslipidemia followed-up for ≥3 years (from 1999 to 2022) in the outpatient Lipid Clinic of Ioannina University General Hospital, Greece. The primary endpoint was the association between baseline ALP and incident ASCVD after adjusting for traditional risk factors (i.e., sex, age, hypertension, diabetes, smoking, and dyslipidemia), baseline ASCVD, and lipid-lowering treatment. ALP levels were stratified by tertiles as follows: low: <67 U/L, middle: 67-79 U/L, high: ≥79 U/L.
    Results: Overall, 1178 subjects were included; 44% were males, and their median age was 57 years (range: 49-65). During a 6-year median follow-up (interquartile range: IQR: 4-9), 78 new ASCVD events (6.6%) occurred. A statistically significant association between baseline ALP levels and incident ASCVD was demonstrated (Odds Ratio, OR: 6.99; 95% Confidence Interval, CI: 2.29-21.03,
    Conclusions: The present study indicates an association between ALP and the development of ASCVD in patients with dyslipidemia, which underscores the potential of ALP as a predictive tool or a therapeutic target in the realm of ASCVD prevention within this population.
    Language English
    Publishing date 2024-02-15
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2777082-5
    ISSN 2308-3425 ; 2308-3425
    ISSN (online) 2308-3425
    ISSN 2308-3425
    DOI 10.3390/jcdd11020060
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Effects of Lipid-Modifying and Other Drugs on Lipoprotein(a) Levels-Potent Clinical Implications.

    Koutsogianni, Amalia Despoina / Liamis, George / Liberopoulos, Evangelos / Adamidis, Petros Spyridonas / Florentin, Matilda

    Pharmaceuticals (Basel, Switzerland)

    2023  Volume 16, Issue 5

    Abstract: The past few years have shown an ongoing interest in lipoprotein(a) (Lp(a)), a lipid molecule that has been proven to have atherogenic, thrombogenic, and inflammatory properties. Several lines of evidence, indeed, have demonstrated an increased risk of ... ...

    Abstract The past few years have shown an ongoing interest in lipoprotein(a) (Lp(a)), a lipid molecule that has been proven to have atherogenic, thrombogenic, and inflammatory properties. Several lines of evidence, indeed, have demonstrated an increased risk of cardiovascular disease as well as calcific aortic valve stenosis in patients with elevated Lp(a) levels. Statins, the mainstay of lipid-lowering therapy, slightly increase Lp(a) levels, while most other lipid-modifying agents do not significantly alter Lp(a) concentrations, except for proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. The latter have been shown to reduce Lp(a) levels; however, the clinical significance of this effect has not been clearly elucidated. Of note, the pharmaceutical lowering of Lp(a) may be achieved with novel treatments specifically designed for this purpose (i.e., antisense oligonucleotides (ASOs) and small interfering RNAs (siRNAs)). Large clinical trials with cardiovascular outcomes with these agents are ongoing, and their results are eagerly awaited. Furthermore, several non-lipid-modifying drugs of various classes may influence Lp(a) concentrations. We have searched MEDLINE, EMBASE, and CENTRAL databases up to 28 January 2023 and summarized the effects of established and emerging lipid-modifying drugs and other medications on Lp(a) levels. We also discuss the potent clinical implications of these alterations.
    Language English
    Publishing date 2023-05-16
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2193542-7
    ISSN 1424-8247
    ISSN 1424-8247
    DOI 10.3390/ph16050750
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Hyponatremia in Patients with Hematologic Diseases.

    Koumpis, Epameinondas / Florentin, Matilda / Hatzimichael, Eleftheria / Liamis, George

    Journal of clinical medicine

    2020  Volume 9, Issue 11

    Abstract: Hyponatremia is the most common electrolyte disorder in clinical practice and is associated with increased morbidity and mortality. It is frequently encountered in hematologic patients with either benign or malignant diseases. Several underlying ... ...

    Abstract Hyponatremia is the most common electrolyte disorder in clinical practice and is associated with increased morbidity and mortality. It is frequently encountered in hematologic patients with either benign or malignant diseases. Several underlying mechanisms, such as hypovolemia, infections, toxins, renal, endocrine, cardiac, and liver disorders, as well as the use of certain drugs appear to be involved in the development or the persistence of hyponatremia. This review describes the pathophysiology of hyponatremia and discusses thoroughly the contributing factors and mechanisms that may be encountered specifically in patients with hematologic disorders. The involvement of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion and renal salt wasting syndrome (RSWS) in the development of hyponatremia in such patients, as well as their differential diagnosis and management, are also presented. Furthermore, the distinction between true hyponatremia and pseudohyponatremia is explained. Finally, a practical algorithm for the evaluation of hyponatremia in hematologic patients, as well as the principles of hyponatremia management, are included in this review.
    Language English
    Publishing date 2020-11-19
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm9113721
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: An overview of diagnosis and management of drug-induced hypomagnesemia.

    Liamis, George / Hoorn, Ewout J / Florentin, Matilda / Milionis, Haralampos

    Pharmacology research & perspectives

    2021  Volume 9, Issue 4, Page(s) e00829

    Abstract: Magnesium (Mg) is commonly addressed as the "forgotten ion" in medicine. Nonetheless, hypomagnesemia should be suspected in clinical practice in patients with relevant symptomatology and also be considered a predisposing factor for the development of ... ...

    Abstract Magnesium (Mg) is commonly addressed as the "forgotten ion" in medicine. Nonetheless, hypomagnesemia should be suspected in clinical practice in patients with relevant symptomatology and also be considered a predisposing factor for the development of other electrolyte disturbances. Furthermore, chronic hypomagnesemia has been associated with diabetes mellitus and cardiovascular disease. Hypomagnesemia as a consequence of drug therapy is relatively common, with the list of drugs inducing low serum Mg levels expanding. Culprit medications linked to hypomagnesemia include antibiotics (e.g. aminoglycosides, amphotericin B), diuretics, antineoplastic drugs (cisplatin and cetuximab), calcineurin inhibitors, and proton pump inhibitors. In recent years, the mechanisms of drug-induced hypomagnesemia have been unraveled through the discovery of key Mg transporters in the gut and kidney. This narrative review of available literature focuses on the pathogenetic mechanisms underlying drug-induced hypomagnesemia in order to increase the insight of clinicians toward early diagnosis and effective management.
    MeSH term(s) Animals ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Magnesium/blood ; Magnesium/metabolism ; Magnesium Deficiency/blood ; Magnesium Deficiency/etiology
    Chemical Substances Magnesium (I38ZP9992A)
    Language English
    Publishing date 2021-07-04
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2740389-0
    ISSN 2052-1707 ; 2052-1707
    ISSN (online) 2052-1707
    ISSN 2052-1707
    DOI 10.1002/prp2.829
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Hyponatremia in patients with heart failure beyond the neurohormonal activation associated with reduced cardiac output: A holistic approach.

    Christopoulou, Eliza / Liamis, George / Naka, Katerina / Touloupis, Panagiotis / Gkartzonikas, Ilias / Florentin, Matilda

    Cardiology

    2022  

    Abstract: Background: Heart failure (HF)is considered an epidemic disease with considerable morbidity, mortality and immense healthcare costs. Electrolyte abnormalities are often encountered in patients with HF posing a diagnostic and therapeutic challenge for ... ...

    Abstract Background: Heart failure (HF)is considered an epidemic disease with considerable morbidity, mortality and immense healthcare costs. Electrolyte abnormalities are often encountered in patients with HF posing a diagnostic and therapeutic challenge for clinicians. Hyponatremia affects up to one third of HF patients and represents an unfavorable prognostic factor.
    Summary: Low sodium levels in HF are mainly attributed to the neurohormonal activation secondary to decreased effective circulating volume. However, patients with HF often have several co-morbidities which may cause or exacerbate the pre-existing hyponatremia. Factors that provoke HF, such as alcohol overconsumption, may also be involved in hyponatremia development. Furthermore, drugs which are frequently prescribed to HF patients, especially diuretics, are potential culprits of hyponatremia and should always be addressed, since their withdrawal may reverse hyponatremia. Despite the great prevalence and the deleterious effects hyponatremia in these patients, it is often overlooked and consequently undertreated. In this review we present the mechanisms involved in the development of hyponatremia focusing on those besides neurohormonal activation. We also discuss the proper management of this electrolyte disorder which is frequently complex in patients with HF.
    Key messages: Hyponatremia in patients with HF is not only the result of neurohormonal activation; several co-morbidities and frequently used drugs should also be addressed. Hence, a holistic approach is required both for the diagnosis and optimal treatment.
    Language English
    Publishing date 2022-09-21
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 80092-2
    ISSN 1421-9751 ; 0008-6312
    ISSN (online) 1421-9751
    ISSN 0008-6312
    DOI 10.1159/000526912
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: High-Density Lipoprotein Cholesterol and Hyponatremia: An Unsolved Gordian Knot.

    Barkas, Fotios / Elisaf, Moses / Liamis, George

    The American journal of medicine

    2019  Volume 132, Issue 2, Page(s) e47–e48

    MeSH term(s) Cholesterol, HDL ; Humans ; Hypertension ; Hyponatremia
    Chemical Substances Cholesterol, HDL
    Language English
    Publishing date 2019-01-19
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 80015-6
    ISSN 1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
    ISSN (online) 1555-7162 ; 1873-2178
    ISSN 0002-9343 ; 1548-2766
    DOI 10.1016/j.amjmed.2018.10.010
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: Association of Fatty Liver Index with Incident Diabetes Risk in Patients Initiating Statin-Therapy: A 6-Year Retrospective Study.

    Anastasiou, Georgia / Liberopoulos, Evangelos / Petkou, Ermioni / Koutsogianni, Amalia Despoina / Adamidis, Petros Spyridwnas / Liamis, George / Ntzani, Evangelia / Barkas, Fotios

    Diagnostics (Basel, Switzerland)

    2023  Volume 13, Issue 3

    Abstract: Background: Statins are associated with new-onset type 2 diabetes (T2D), mainly in patients with metabolic syndrome (MetS). The fatty liver index (FLI) is used as a prognostic score for the diagnosis of non-alcoholic fatty liver disease (NAFLD), which ... ...

    Abstract Background: Statins are associated with new-onset type 2 diabetes (T2D), mainly in patients with metabolic syndrome (MetS). The fatty liver index (FLI) is used as a prognostic score for the diagnosis of non-alcoholic fatty liver disease (NAFLD), which is common in patients with MetS. We aimed to investigate the association of FLI with new-onset T2D in patients initiating statin therapy.
    Methods: A retrospective observational study including 1241 individuals with dyslipidemia and followed up for ≥3 years. Patients with T2D and those receiving lipid-lowering treatment at the baseline visit were excluded. Models with clinical and laboratory parameters were used to assess the association of FLI with incident T2D.
    Results: Among the 882 eligible subjects, 11% developed T2D during the follow-up (6 years; IQR: 4-10 years). After adjusting for sex, age and MetS parameters, a multivariate analysis revealed that age (HR:1.05; 95%CI: 1.01-1.09,
    Conclusions: FLI is significantly and independently associated with new-onset T2D risk in patients initiating statin therapy.
    Language English
    Publishing date 2023-01-30
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662336-5
    ISSN 2075-4418
    ISSN 2075-4418
    DOI 10.3390/diagnostics13030503
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  10. Article ; Online: Hyponatremia in Acute Stroke: To Treat or Not to Treat?

    Barkas, Fotios / Liamis, George / Milionis, Haralampos

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

    2019  Volume 28, Issue 12, Page(s) 104421

    MeSH term(s) Brain Ischemia ; Humans ; Hyponatremia ; Stroke
    Language English
    Publishing date 2019-10-01
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1131675-5
    ISSN 1532-8511 ; 1052-3057
    ISSN (online) 1532-8511
    ISSN 1052-3057
    DOI 10.1016/j.jstrokecerebrovasdis.2019.104421
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