Athanasia Papazafiropoulou

Tzaneio General Hospital of Piraeus · First Department of Internal Medicine

Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have emerged as a promising therapeutic option for hyperglycemia and its complications. However, metformin remains the first-line pharmacological treatment in most algorithms for type 2 diabetes (T2D). Although metformin is generally believed to exert positive effects on cardiovascular (CV) outcom...

Background and Aims: It is known that SGLT-2 inhibitors and GLP-1 agonists show a favorable profile in the reduction of body weight as well as blood pressure (BP). Therefore, the purpose of this study is to evaluate the effect of SGLT-2 inhibitors and GLP-1 agonists on ambulatory BP in patients with poorly controlled type 2 diabetes (T2D). Material...

Objective It is known that both liraglutide and empagliflozin, except for their anti-hyperglycaemic effect, have a favorable effect on major cardiovascular outcomes. Furthermore, it has been shown that they reduce systolic (SBP) and to a lesser extent diastolic blood pressure (DBP). Therefore, the purpose of this study is to evaluate the effect of...

Patients with diabetes mellitus(DM) and foot ulcers have an increased morbidity and mortality. The aim of this study was to investigate the isolation of fungi in diabetic patients with foot ulcers and furthermore epidemiological and clinical characteristics of these patients. During the period of January 2015 - August 2019, 321 samples of foot ulce...

Patients with type 2 diabetes are at high risk for cognitive decline and dementia. Despite the limited data on the possible pathogenetic mechanisms, evidence suggests that cognitive decline, and thus dementia and Alzheimer’s disease, might arise from a complex interplay between type 2 diabetes and the aging brain, including decreased insulin signal...

Background and Aims: Liraglutide, has been found to reduce systolic (SBP) and to a lesser extent diastolic blood pressure (DBP). The purpose of this study is to evaluate the effect of liraglutide on ambulatory BP in patients with poorly controlled type 2 diabetes (T2D). Materials and Methods: A total of 42 patients (20 men) with T2D, mean age (± st...

Aims To estimate and compare the prescription costs for the management of patients with diabetes over a period of 20 years in Greece, based on real world data. Methods The records of outpatients with T2D, monitored at three diabetes centres, were examined in four cross-sections (1998, 2006, 2012, 2018). Prescribed medicines per patient, along with...

Background: Strict glycaemic control early in the treatment process has been shown to reduce the occurrence of micro- and macro- vascular complications of diabetes in the long-term. Thus, treatment guidelines advise early intensification of treatment to achieve glycaemic control goals. However, evidence in Greece suggests that, despite guideline r...

The aim of the present study was to estimate the relationship between arterial stiffness, expressed in terms of pulse wave velocity (PWV) and augmentation index (AIx), with stroke severity and outcome.

Background and Aims: Sleep disturbances are common among individuals with type 2 diabetes (T2D). The aim of this study was to estimate the prevalence and correlates of sleep disorders in Greek diabetics and differences between an urban and semi-urban population. Materials and Methods: The study population was comprised of 308 T2D patients [139 pati...

Diabetes mellitus (DM) is an established risk factor for cardiovascular morbidity and mortality. The beneficial effects of sodium-glucose cotransporter 2 (SGLT-2) inhibitors for achieving improved glycemic control, combined with the cardiovascular protection exhibited by this category of agents, have deemed them a treatment of choice for subjects w...

OBJECTIVE To estimate adherence to the Mediterranean diet among patients with type 2 diabetes mellitus (DM) and to compare the rates between urban and rural populations. METHOD The study was conducted with 139 patients with DM (80 males) attending the outpatient diabetic clinic of the “Tzaneio” General Hospital in Pireus (an urban population) and 1...

The detrimental effects of constant hyperglycemia on neural function have been quantitatively and qualitatively evaluated in the setting of diabetes mellitus. Some of the hallmark features of diabetic encephalopathy (DE) are impaired synaptic adaptation and diminished spatial learning capacity. Chronic and progressive cognitive dysfunction, perpetu...

Numerous micro-organisms naturally reside in the human body assuming a symbiotic, or, at times, even a dysbiotic relationship with the host. These microbial populations are referred to as the human microbiota. Host microbial populations are an important mediator of gastro-intestinal mucosal permeability, bile acid metabolism, short-chain fatty acid...

The obesity pandemic poses a unique set of problems related to acute pancreatitis, by both increasing its incidence and worsening its severity. This review explores how obesity may contribute to increasing the incidence of acute pancreatitis, and the role of lipolytic unsaturated fatty acid release in worsening acute pancreatitis. It delineates the...

Epicardial adipose tissue is defined as a deposit of adipocytes with pathophysiological properties similar to those of visceral fat, located in the space between the myocardial muscle and the pericardial sac. When compared with subcutaneous adipose tissue, visceral adipocytes show higher metabolic activity, lipolysis rates, increased insulin resist...

Background The influence of biomarkers in human lifespan has been investigated but with no clear results yet. Materials and methods Lipids, Uric Acid (UA), Adiponectin (ADIPOQ), Insulin-like Growth Factor (IGF-1), cholesteryl ester transfer protein (CETP) and angiotensin-converting enzyme (ACE) proteins, as well as CETP, ADIPOQ, insulin-like growt...

Recent studies have demonstrated that stromal derived factor-1α (SDF-1α) is a substrate of dipeptidyl-peptidase-4 (DPP-4) inhibitors. It has also been shown that SDF-1α shares anti-apoptotic as well as nephroprotective properties and exerts a beneficial effect in the cardiovascular system. Therefore, the aim of this study was to estimate the effect...

Diabetes mellitus (DM) is an established risk factor for cardiovascular morbidity and mortality. The beneficial effect of improved glycemic control on cardiovascular complications has been well documented, but some clinical studies suggest that certain antidiabetic drugs may increase cardiovascular risk, despite being effective in lowering blood gl...

It is true that a primary goal of diabetes early diagnosis and treatment is quality of life (QoL). The term QoL is still confusing but it is agreed that it composes of four components: The physical component, mental, cogitative component, psychological and social component. Many articles have been written addressing those four components. During th...

. Castleman’s disease (CD) is a rare lymphoproliferative disorder. CD is divided into two clinical subtypes: the most common unicentric and the less usual multicentric subtype. The majority of unicentric CD affects the mediastinum, while neck, abdomen, and axilla are less common locations. Case Presentation . Herein, we describe a rare case of unic...

Pre-diabetes is a state characterized by insulin resistance and increased arterial stiffness. Arterial stiffness represents a well-established cardiovascular risk factor. The traditional cardiovascular risk factors (insulin resistance, decreased circulating endothelial progenitor cells, and increased asymmetric dimethylarginine (ADMA) levels) expla...

Background: Diabetes mellitus type 2 (T2D) is a chronic metabolic disease with a great impact on health status and quality of life (QoL) in terms of physical, social, and psychological well-being. The aim of the present study was to measure diabetes-dependent QoL and affecting factors in patients with T2D. Methods: Study population was consisted...

Background: It is well established that there is an important genetic predisposition for type 2 diabetes mellitus (T2DM). Objective: To summarise available epidemiological data regarding T2DM transmission in various populations. Method: Narrative review. Results: The estimated risk for the diagnosis of T2DM increases approximately by 2-4 tim...

Targeting the incretin system with glucagon-like peptide (GLP)-1 receptor agonists has become an important therapeutic approach for treating type 2 diabetes mellitus (DM). Recently, weekly administration of GLP-1 agonists has been shown to improve glycemic control while reducing body weight in patients with type 2 DM. With these agents the incidenc...

Platelet dysfunction plays a role in diabetic macrovascular complications. Several studies have assessed the effect of oral hypoglycemic agents (OHAs) on platelet function. Data from both in vivo and in vitro studies show a favorable effect for most of the traditional glucose-lowering therapies, while evidence is limited for the newer ones. Metform...

Microvascular complications are common in patients with type 2 diabetes mellitus. According to the results of recent studies (ADVANCE, VADT, ACCORD), achievement of glycemic control and blood pressure targets have only minor impact on microvascular complications. In 2005, the FIELD study showed that fenofibrate reduces the need for laser treatment...

Obesity is a chronic disease with a high prevalence in both developed and developing countries. Lifestyle interventions, such as restricting calorie consumption and increasing physical activity, continue to be the cornerstone of weight-reduction programs. Novel anti-obesity drug therapies are currently gaining in importance. These include lorcaseri...

Aim: Hypoglycaemia is considered a factor contributing to morbidity and mortality in patients with diabetes. The aim of the present study was to examine the frequency, clinical characteristics, predisposing factors and outcomes of iatrogenic hypoglycaemia requiring medical assistance. Methods: Eight hospitals participated in this prospective sur...

Glucagon-like peptide-1 (GLP-1) is considered to be the most important of the incretin hormones (incretins), which are gastrointestinal hormones that are secreted after meals and reduce postprandial hyperglycemia. Apart from its action on the pancreatic islets, GLP-1 has a variety of extrapancreatic effects on the heart, blood vessels and the gastr...

The skin may exhibit the first clinical evidence of a systemic disease and may provide the first clues to a diagnosis in malignancies. Erythroderma is defined as generalized redness and scaling and it is a clinical manifestation of a variety of underlying diseases including, rarely, solid tumors. Breast cancer is associated with a variety of skin p...

Introduction Giant cell arteritis is the most common form of large-vessel vasculitides. However, it is probable that extracranial involvement is underdiagnosed in patients with classical giant cell arteritis. In the recent literature most cases of giant cell arteritis have been described in conjunction with aortic aneurysms or dissections. Nonethel...

The aim of the present study is to examine the clinical indices related to cardiovascular risk management of Greek patients with type 2 diabetes, before and after the major economic crisis that emerged in the country. In this retrospective database study, the medical records of patients with type 2 diabetes treated at three diabetes outpatient cent...

The present brief review looks at the evidence on the role of GLP-1 and its agonists in osteopenia and osteoporosis in type 2 diabetes (T2DM). There is accumulating data to suggest a favourable effect of GLP-1 on bone metabolism. However, most data is from experimental studies, while clinical confirmation is still inadequate. Moreover, little is kn...

Benign prostatic hyperplasia (BPH) represents a pattern of non-malignant growth of prostatic fibromuscular stroma. Metabolic disturbances such us pre-diabetes and metabolic syndrome may have a role in BPH pathophysiology. A potential explanation for the above relationship involves the insulin-like growth factor (IGF) axis as well as IGF binding pro...

The aim of the present survey was to evaluate nurses' knowledge regarding sepsis in Greece. A total of 835 registered nurses (125 males/710 females) from tertiary hospitals in Greece were interviewed from April 2008 to December 2009. All participants completed a self-completed questionnaire about assessment of sepsis (see Figure 1). Basic demograph...

Dessert compositions may conform to diabetic diet when it contains low sugar or artificial sweetener to replace sugar. However, it is still questionable whether glycemic control in type 2 diabetes patients is improved by the use of diet-conforming dessert compositions. To compare, in type 2 diabetes patients, the glycemic, insulin, and C-peptide re...

Resistin is a recently described adipokine which is expressed in low levels in human adipose tissue, pulmonary tissue and resting endothelial cells, and in high levels in mononuclear leukocytes, macrophages, and spleen and bone marrow cells. Serum levels of resistin have been found to be elevated in obese subjects and in subjects with insulin resis...

Creatinine, a muscle waste product, is widely interpreted as a measure of renal function. However, the serum level reflects not only renal excretion, but also the generation, intake, and metabolism of creatinine. In stable normal or reduced renal function they are determined by the rate of creatinine production and the endogenous creatinine clearan...

Background: Diabetes Mellitus (DM) is a major cause of morbidity and mortality affecting millions of people worldwide, while placing a noteworthy strain on public health funding. There is limited information regarding the determintants of the quality of life of diabetic patients with neuropathy in Greece. Aim: The aim of this study was to assess he...

Type 2 diabetes is a major health problem reaching epidemic dimensions. Its complications, micro- and macrovascular have a great impact in health economics as well as in diabetic patient's quality of life. The main pathogenetic disorders leading to the clinical manifestation of T2D are insulin resistance and β-cell failure. Preventing strategies, e...

Omega-3 fatty acids except for their effect on triglycerides levels have cardioprotective properties as well as antiarrhythmic properties.The pleiotropic effects of omega-3 fatty acids, also, include lowering of blood pressure and the favorable effect on endothelial function and high-density cholesterol levels. Furthermore, studies have showed thei...

Cardiovascular disease (CVD) is leading cause of morbidity and worldwide. Higher levels of low-density lipoprotein cholesterol (LDL-C) are associated with an increased risk of coronary heart disease (CHD), myocardial infarction, and stroke. Guidelines of the Adult Treatment Panel III emphasize intensive reduction of LDL or non-high-density lipoprot...

The present review summarizes the existing literature data regarding the development of newer categories of antidiabetic agents, their mechanism of action and their clinical importance. In this paper, a review of the recent patents for the treatment of diabetes will be presented. In recent years significant achievements have been done, including th...

The aim of the present study was to investigate whether selenium levels differ between type 2 diabetic subjects with and without coronary artery disease (CAD). A total of 200 subjects with type 2 diabetes (100 with CAD and 100 without CAD), consecutively selected from the diabetes outpatient clinic of our hospital were enrolled into the study. A de...

Except for the established risk factors, presence of target organ damage has an important role in the treatment of hypertensive subjects. The aim of the present study was to estimate the prevalence of target organ damage in primary care subjects. This multi-centre, cross-sectional survey of 115 primary care physicians recruited 1095 consecutive sub...

Long-term exposure to environmental pollution has been associated with an increased incidence of diabetes. In addition, environmental pollution has been associated with higher relative risk of mortality among people with diabetes compared to the general population. An association between exposure to air pollution and markers of cardiovascular risk...

Glucagon-like peptide-1 (GLP-1) is involved in satiety control and glucose homeostasis. Besides, GLP-1 has cardiovascular effects. In experimental models, GLP-1 increases cardiac output and exerts a direct vasodilatory effect. In animals with dilated cardiomyopathy GLP-1 improves left ventricular performance. Human data demonstrated that GLP-1 redu...

Type 2 diabetes mellitus (T2DM) is a major risk factor for peripheral arterial disease (PAD). A simple, noninvasive method for the estimation of PAD is ankle brachial index (ABI). The aim of the present study was to determine whether there is an association between ABI and cardiovascular risk factors in T2DM subjects without apparent macrovascular...

Self-medication is an important driver of antimicrobial overuse as well as a worldwide problem. The aim of the present study was to estimate the use of antibiotics, without medical prescription, in a sample of rural population presenting in primary care in southern Greece. The study included data from 1,139 randomly selected adults (545 men/594 wom...

Diabetic subjects, especially women, show high prevalence of asymptomatic bacteriuria (ASB). The aim of the present study was to evaluate the prevalence of ASB in subjects with type 2 diabetes mellitus (T2D) with and without microalbuminuria (MA). A hundred diabetic subjects with MA (53 males/47 females, mean age +/- standard deviation: 65.5 +/- 11...

Subjects with type 2 diabetes mellitus (T2DM) have increased morbidity and mortality mainly due to macrovascular complications. In addition, diabetic patients show increased in-hospital admissions in comparison with nondiabetic patients. However, in-hospital mortality data for patients with T2DM are not available in our country. The aim of the pres...

The aim of the present study was to determine the prevalence of thyroid dysfunction in patients with type 2 diabetes (T2D) attending an outpatient clinic. We examined thyroid dysfunction in a total of 1,092 patients with T2D. Prevalence rate of thyroid dysfunction was 12.3%. In the group with thyroid dysfunction there was an excess of females in co...

Objective To examine the goal attainment rates for patients with diabetes mellitus with respect to glycemic, lipid and blood pressure control. Method Data were abstracted from the medical records of patients with diabetes mellitus who visited 4 primary care units during the year 2007-2008. In total, 673 diabetic subjects (353 women and 320 men) wer...

Table S2. Univariate and multivariate logistic analysis: the association between various parameters with HPV infection in the study population.

Table S1. The demographic characteristics of the study population [the variables are expressed as n (%)].

Metabolic syndrome (MetS) is common and is associated with increased cardiovascular morbidity and mortality. Recent prospective studies suggested that MetS is associated with increased risk of heart failure. In the present cross-sectional study, we examined the association between left ventricular myocardial performance with MetS. A total of 550 no...

Human papillomavirus (HPV) infection is a causative factor for cervical cancer. Early detection of high risk HPV types might help to identify women at high risk of cervical cancer. The aim of the present study was to examine the HPV prevalence and distribution in cervical smears in a sample of Greek women attending a gynecological outpatient clinic...

Increased arterial stiffness is a marker of atherosclerosis and is recognised early in the course of type 2 diabetes mellitus (T2DM). Matrix metalloproteinases (MMP) and their tissue inhibitors (TIMP) are a family of proteolytic enzymes which are essential for the structure and function of large arteries. In this study, we examined for relationship...

Road traffic accidents are one of the most common causes of death and disability especially among young people. young people, males, alcohol or drug consumers and users of cellular phones are all more likely to be involved in a road traffic accident. In addition, various characteristics of the vehicle and road conditions may interact with the above...