John Lakoumentas

BackgroundThe medial patellofemoral ligament (MPFL) has been investigated widely in the past 30 years, resulting in many research achievements in this field.PurposeTo perform a comprehensive bibliometric analysis to evaluate the 100 top-cited articles on the MPFL.Study DesignCross-sectional study.MethodsWe searched the Scopus database in December 2022 using the terms “medial patellofemoral ligament” OR “MPFL.” The search was confined to English-language articles, including technical notes, systematic reviews on clinical outcomes and/or complications, clinical studies, studies regarding complications, and basic science articles (either cadaveric or biomechanical); we excluded letters, case reports, personal opinions, guidelines, editorials, and narrative or other types of reviews. Analysis of the 100 top-cited articles was performed according to total number of citations, average citations per year (ACY …

BackgroundAllergic rhinitis (AR) is a common respiratory disease encompassing a variety of phenotypes. Patients can be sensitized to one or more allergens. There are indications that polysensitization is associated with more severe disease. However, the extent to which the level of sensitization is associated to clinical disease variability, underlying the distinct nature of AR from AR+ conjunctivitis or AR+ asthma, is not known.ObjectiveThe aim of this study was to evaluate phenotypical differences between mono- and poly-sensitized patients with AR and to quantify their symptomatic variability.Methods565 patients with a confirmed diagnosis of AR were included in this cross-sectional study. 155 were mono-sensitized and 410 poly-sensitized. Interactions between sensitization levels and reporting of different symptoms of AR and co-morbidities, disease duration and impact, were assessed. Furthermore, patients …

A sharp increase in early syphilis cases in a referral hospital in Athens, Greece, 2 years into the COVID-19 pandemic A sharp increase in early syphilis cases in a referral hospital in Athens, Greece, 2 years into the COVID-19 pandemic J Eur Acad Dermatol Venereol. 2024 Feb 21. doi: 10.1111/jdv.19884. Online ahead of print. Authors E Nicolaidou 1 , K Fouseki 1 , V Paparizos 1 , O Kotsafti 1 , V Vasalou 1 , E Daskalakis 1 , J Lakoumentas 2 , A Giannoukos 1 , G Emmanouil 1 , R Kapranou 1 , Z Kripouri 1 , S Papanikou 3 , I Stefanaki 1 , A Tagka 1 , S Gregoriou 1 , E Paparizou 1 , A Stratigos 1 Affiliations 1 1st Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital, Athens, Greece. 2 Statistician, Athens, Greece. 3 Department of Dermatology, National Health System, "A. Sygros" Hospital, Athens, Greece. PMID: 38380596 DOI: 10.1111/jdv.…

MethodsThe design was a Randomized control trial. The setting was an outpatient Balance Rehabilitation Clinic in a tertiary University Hospital. Results from 20 women all of them fallers, 10 in the intervention group and 10 in the control group (no intervention) were analyzed. Older women with falls in their anamnesis were evaluated with the mCTSIB test of the dynamic platform as a screening test, and if pathological also with the miniBEST test and the SPPB test. Based on the miniBEST (less than 18) the woman was placed randomly in the intervention or the control group. The intervention group completed a total of 36 sessions, 3 times per week for 30 min. The control group had no intervention.ResultsDynamic platform exercise programs are proved to be effective (mini-BEST p< 0.006 and mCTSIB p< 0.02, SPPB p< 0.02) to balance rehabilitation and therefore to fall prevention. The results show also that a good compliance was achieved with ap< 0.001, and a% of patient that adhere to the protocol up to 96%ConclusionWe can conclude that that fall prevention exercises on a dynamic platform are effective and with good compliance.

Aim To investigate the routine guidance provided by pediatricians concerning the timing of complementary feeding (CF) for both healthy infants and those at a heightened risk of allergies. Methods A total of 233 pediatricians participated in an anonymous online survey that included questions about demographics and recommendations for CF. Specifically, they provided guidance on the types of foods, preparation methods, supplements, time intervals for introducing new foods to infants at low and high allergy risk, and delayed food introductions for high-risk cases. Results The respondents advised introducing certain foods at specific ages: fruits, starchy non-gluten grains, vegetables, olive oil, and meat were appropriate at 6 months; gluten-rich grains at 7 months; yogurt, hard-boiled eggs, and legumes at 8 months; fish at 8.5 months; and nuts at 9 months. Pediatricians, especially those with less than 15 years of practice, often introduced egg, seafood, gluten-rich grains, legumes, and nuts earlier for high-risk infants. Parenthood and male gender were associated with the earlier introduction of eggs and grains. Conclusions Greek pediatricians follow a structured food introduction schedule for CF in infants. Interestingly, they tend to delay the introduction of common food allergens and recommend longer intervals between introducing new foods, particularly for high-risk infants. Key Notes: Despite recent evidence-based indications on healthy complementary feeding strategies for infants, discrepancies persist among pediatricians regarding food choices and the order and timing of food introduction, both for healthy infants and those at risk of allergy …

Acute respiratory infections are a major cause of morbidity and mortality in children worldwide. Dietary and nutritional interventions, including minerals and vitamin supplementation, have been explored as potential treatments for these infections. However, the evidence on their efficacy is limited and inconclusive. This systematic review and meta‐analysis aim to provide a comprehensive summary of the available evidence on the effectiveness of dietary and nutritional interventions for treating acute respiratory tract infections in children. A systematic review was conducted according to the PRISMA 2020 guidelines in April 2022 and updated in April 2023. Clinical trials focusing on dietary or nutritional interventions, including supplementations, in children with acute respiratory tract infections were included. The selection of interventions and outcomes was based on biological plausibility. Data were extracted using a …

Background From early life, respiratory viruses are implicated in the development, exacerbation and persistence of respiratory conditions such as asthma. Complex dynamics between microbial communities and host immune responses shape immune maturation and homeostasis, influencing health outcomes. We evaluated the hypothesis that the respiratory virome is linked to systemic immune responses, using peripheral blood and nasopharyngeal swab samples from preschool‐age children in the PreDicta cohort. Methods Peripheral blood mononuclear cells from 51 children (32 asthmatics and 19 healthy controls) participating in the 2‐year multinational PreDicta cohort were cultured with bacterial (Bacterial‐DNA, LPS) or viral (R848, Poly:IC, RV) stimuli. Supernatants were analysed by Luminex for the presence of 22 relevant cytokines. Virome composition was obtained using untargeted high throughput …

After a myocardial infarction, the inflammatory response is connected to major adverse outcomes such as ischemia-reperfusion injury, adverse cardiac remodeling, infarct size and poor prognosis. INFlammatIoN amI sTudY (INFINITY) is a multicenter, prospective, observational, cohort study designed to investigate the prognostic role of the cytokines IL-6, IL-10, IL-18 and IL-17 and the adipokines leptin, apelin and chemerin in patients with acute coronary syndrome. The study will test if these inflammatory biomarkers reflect different clinical manifestations of coronary artery disease and have a prognostic role in a 6-month follow-up period. This study represents an opportunity to investigate further the prognostic role of a selected combination of proinflammatory and anti-inflammatory biomarkers in the prognosis and risk stratification of acute coronary syndrome patients.

BackgroundKnee osteoarthritis is a disease linked to severe pain and disability and several methods have been used to aid alleviate its symptoms, with varying degrees of success. Cooled radiofrequency ablation (CRFA) and cryoneurolysis (CRYON) are two novel methods under investigation for their capacity to control pain in knee osteoarthritis, while keeping a low complication rate. In this study the two methods will be compared with sham surgery, giving us an opportunity to compare their results.MethodsIn this prospective, randomized, sham-controlled, double-blind trial 60 patients suffering from knee osteoarthritis will be recruited using a diagnostic block of the genicular nerves under ultrasound guidance. Three groups will be created: cooled radiofrequency ablation group (24 patients), cryoneurolysis group (24 patients) and sham group (12 patients), through software randomization. Target of the interventions will be the three main genicular nerves; superior medial, superior lateral and inferior medial as well as the suprapatellar branch. The primary objective of this clinical trial is to evaluate the efficacy of CRFA or CRYON in comparison to sham surgery at 2-, 4-, 12-and 24-weeks post intervention using the Numerical Rating Pain Scale. Secondary objectives will be the safety of the 2 main techniques, as well as the clinical outcomes at 12-and 24-weeks post intervention using the Knee Injury and Osteoarthritis Outcome Score, the Oxford Knee Score and the 7-point scale of Patient Global Impression of Change.DiscussionThese two novel techniques are able to block the pain transmission through the genicular nerves via different ways. In …

Background Schoolchildren are likely to consume meals and snacks at school, with a possibility of allergic food reactions and anaphylaxis in the school environment. The school personnel should be informed of the presence of schoolchildren with food allergy (FA) and need to be trained in the management of allergic reactions, as to prepare them to intervene appropriately when necessary. Limited knowledge of FA and its management is documented globally among school staff and there is no uniform protocol in schools. Methods In this observational cross-sectional study, teachers at state schools throughout Greece completed an online anonymous questionnaire on their awareness of FA reactions and the plans for the management of medical emergencies in their schools of employment. Results Among the 289 teachers who responded the online invitation, 203 (70.24%) were female and 157 (54%) were aged under 40 years. Females expressed a higher level of concern about the presence of school personnel trained to manage FA symptoms (p = 0.001), written instructions, and the availability of adrenaline (epinephrine) at school (p < 0.001). A younger age was associated with a higher level of both interest and knowledge on FA management in schools. School directors were more certain about the availability of a special record of children with FA at school (p = 0.01), the availability of adrenaline (p = 0.006), and written guidelines on the management of serious health incidents at school (p = 0.04). Written guidelines instructing children to avoid sharing cutlery, glasses, home-prepared meals, and snacks bought from the school canteen were …

Background Tree nut allergy is usually life-long and potentially life-threatening. Standard of care consists of strict avoidance of the culprit nut and symptomatic treatment of accidental reactions. Objective To evaluate the potential therapeutic options for desensitization of patients with IgE-mediated tree nut allergy, focusing on, but not limited to, immunotherapy. Methods We systematically searched three bibliographic databases for studies published until July 2022 for active treatments of IgE-mediated allergy to tree nuts (walnut, hazelnut, pistachio, cashew, and almond) with allergen-specific immunotherapy (AIT) using oral (OIT), sublingual (SLIT), epicutaneous (EPIT) or subcutaneous (SCIT) delivery, or with other disease-modifying treatments. Results We included 17 studies (three randomized, double-blinded, placebo-controlled, five quasi-experimental prospective cohorts, five prospective cohorts, two retrospective cohorts, and two case reports. Three studies investigated sublingual immunotherapy, five investigated oral immunotherapy to a single tree nut, and six used multi-food oral immunotherapy with (four) or without (two) omalizumab. The remaining studies investigated the effectiveness of monoclonal antibodies in multi-food allergic patients, including patients with a tree nut allergy. The heterogeneity of the studies prevented pooling and meta-analysis. Conclusion Even though strict avoidance remains the standard of care for patients with tree nut allergy, alternative approaches have been tested in clinical trials and real-life studies. These new concepts require further investigation with more well-designed studies including well …

Background Dietary and environmental factors may influence tolerance acquisition in food protein-induced allergic proctocolitis (FPIAP). This retrospective observational study explored the role of maternal diet during pregnancy and breastfeeding in tolerance acquisition in infantile FPIAP. Methods Breastfed infants with FPIAP from six diverse regions in Greece were divided into two groups, based on development of tolerance to the trigger food: Group A (n = 43), before, and Group B (n = 53), after, the 6th month of age. Maternal diet during pregnancy and breastfeeding was elicited using the Mediterranean Diet Score Questionnaire and the Mediterranean Oriented Culture Specific Semi-Quantitative Food Frequency Questionnaire. Results Mean age at diagnosis of FPIAP (1.5 months) and weaning (5.5 months) were the same in both groups. The main trigger was cow’s milk. Group A received infant milk formula earlier than Group B. Group B had a higher incidence of asthma/wheeze, siblings with milk allergy, maternal smoking and rural residence. On multivariate analysis, earlier resolution of FPIAP was associated with higher maternal education and with salt intake and consumption of goat/sheep cheese during pregnancy and olive oil during breastfeeding. Consumption of multivitamins during pregnancy and meat, winter fruits, green vegetables, butter, salt, “ready-to-eat” meals and pastries during breastfeeding were correlated with longer duration of symptoms. Conclusions Mothers of children with FPIAP to cow’s milk protein can be advised to eat more yogurt, cheese and olive oil during subsequent pregnancies, and avoid multivitamins, grilled …

This study aimed to determine the prevalence of the risk of orthorexia nervosa (ON) in dietetics students in Greece, and its relationship with diet, risk of eating disorder (ED), body mass index (BMI), body image flexibility, and parental attachment. The participants were 132 dietetics students, with a mean age of 22.94 ± 3.5 years, who completed a series of questionnaires that recorded sociodemographic, clinical, and anthropometric characteristics; adherence to the Mediterranean diet (MedDiet); ON indicators as determined by the ORTO-15 questionnaire; body image flexibility, with the Body Image-Acceptance and Action Questionnaire (BI-AAQ-5); the risk for ED as assessed using the EAT-26; anxiety level according to the STAIT 6 instrument; and recollection of their parents’ attitudes towards them during the first 16 years of life, with the Parental Bonding Instrument (PBI). ON risk appeared to be significantly associated with BMI (p = 0.002), exercise frequency (p = 0.023), anxiety level (p = 0.002), risk of ED (p < 0.001), body image inflexibility (p < 0.001), and inversely with the affectionate constraint of maternal bonding (p = 0.036). In conclusion, disordered eating behaviors and body shape concerns are prevalent among dietetics students, with parental attachment to the mother influencing their occurrence. Identification of potential ON and development of prevention mechanisms during childhood could help eliminate these concerns and improve the lives of dietetics students.

The aim of this study was to determine the prevalence of orthorexia nervosa (ON) among professional dancers in Greece, as well as its relationship with nutrition, body mass index (BMI), body image flexibility, and parental bonding. The participants were 96 professional dancers, with a mean age of 23.41 ± 5.13 years, who completed a battery of questionnaires recording sociodemographic, clinical, and anthropometric characteristics; adherence to the Mediterranean diet (MedDiet); indications of ON, as determined by the ORTHO-15 questionnaire; body image flexibility, using the body image-acceptance and action questionnaire (BI-AAQ-5); and their recollection of their parents’ attitudes towards them during the first 16 years of life, with the parental bonding instrument (PBI). The study population was classified into two groups, based on BMI: normal weight, and underweight. ON was shown to be significantly correlated with BMI (p = 0.006)-present in normal weight subjects- and body image inflexibility (p < 0.001). Parental body image inflexibility was significantly correlated with a low bonding relationship as perceived in childhood. In conclusion, disordered eating attitudes and body shape concerns are prevalent among professional dancers and appear to be associated with their parental relationship during childhood. Identification of potential ON and development of preventive mechanisms could help to eliminate such concerns and improve the nutrition of professional dancers.

Tree nut and/or peanut allergy impairs patients’ quality of life, but data on the impact of age and the type of nut or peanut on the quality of life are lacking. To evaluate the impact at different ages, age-appropriate survey questionnaires accompanied by FAQLQ and FAIM were distributed to patients with suspected tree nut and/or peanut allergy who presented at the allergy departments of three hospitals in Athens. Out of 200 questionnaires distributed, 106 met the inclusion criteria (46 children, 26 teenagers, 34 adults). The median score of each age group for FAQLQ was 4.6 (3.3–5.1), 4.7 (3.9–5.5), and 3.9 (3.2–5.1) and for FAIM was 3.7 (3.0–4.0), 3.4 (2.8–4.0), and 3.2 (2.7–4.1), respectively. FAQLQ and FAIM scores were correlated with the reported probability of using the rescue anaphylaxis set upon reaction (15.4%, p = 0.04 and 17.8%, p = 0.02, respectively) and pistachio allergy (FAQLQ: 4.8 vs. 4.0, p = 0.04; FAIM: 3.5 vs. 3.2, p = 0.03). Patients with additional food allergies reported worse FAQLQ scores (4.6 vs. 3.8, p = 0.05). Worse FAIM scores were associated with younger age (−18.2%, p = 0.01) and the number of life-threatening allergic reactions (25.3%, p < 0.001). The overall impact of tree nut and/or peanut allergy on patients’ quality of life is moderate but differs with age, the type of nut, the use of adrenaline, and the number of previous reactions. The aspects of life affected and contributed factors also vary across age groups.

Background: The management of infected metaphyseal nonunion of the tibia is devastating, especially when associated with significant bone loss, poor soft tissues, draining sinuses, axial deformity, knee or ankle joint stiffness, limb discrepancy, and multiresisted pathogens. A systematic review, performed recently by the primary investigators but not yet published, yielded the lack of studies in the field and the huge heterogeneity of the presented results. We found several bias and controversies such as no clear definition of the exact part of the tibia where the nonunion was located, the pathogen causing the fracture-related infection, the number of previous interventions and time to presentation, and the exact type of treatment methods including the use of muscle flaps or bone grafting. Time to final union as a functional score is another important but missing data.Objective: The proposed study is designed to evaluate a sufficient number of patients with infected metaphyseal tibial nonunions using various general health, functional, and bone scores.Methods: This prospective clinical trial study, with a minimum follow-up period of 36 months, focuses on the effectiveness of the Ilizarov method after radical nonunion debridement and targeted antibiotic therapy in patients with infected metaphyseal tibial nonunions. The primary outcomes would be the definite healing of nonunion and infection-free results. Secondary outcomes would be limb alignment and discrepancy, alteration in the patient’s quality of life, and functional results. A power analysis calculated a minimum of 11 patients to obtain statistical power, but we aim to include at least 25 patients …

Introduction Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis. RSV‐induced bronchiolitis has been associated with preschool wheeze and asthma in cohort studies where the comparison groups consist of healthy infants. However, recent studies identify rhinovirus (RV)–induced bronchiolitis as a potentially stronger risk factor for recurrent wheeze and asthma. Aim This systematic review and meta‐analysis aimed to compare the associations of RSV‐ and RV‐induced bronchiolitis with the development of preschool wheeze and childhood asthma. Methods We performed a systematic search of the published literature in five databases by using a MeSH term‐based algorithm. Cohort studies that enrolled infants with bronchiolitis were included. The primary outcomes were recurrent wheeze and asthma diagnosis. Wald risk ratios and odds ratios (ORs) were estimated, along with their 95 …

In the era of evidence-based medicine, physicians worldwide should abide by universally approved practices and healthcare units should seek quality control and operational improvement. This audit evaluates the degree of compliance with the European Academy of Allergy and Clinical Immunology guidelines for the diagnosis and treatment of anaphylaxis in a pediatric Allergy Department. Medical records of 248 children with food-induced allergic reactions who presented both on emergency and outpatient basis were reviewed. Data were also collected from the e-prescription database and anaphylaxis severity was graded according to Sampson’s criteria. An accuracy metric was used to calculate the consistency rate. Anaphylaxis was documented in 188/423 allergic reactions. The degree of agreement for the classification of the reactions as anaphylactic was 88.3%, while the respective rate for non-anaphylactic was 58.7%. In the anaphylactic cases, adrenaline was prescribed in 84.8%, while the respective rates for other drugs were: antihistamines: 27.6%; corticosteroids: 26.1%; inhaled β2-agonists: 11.8%. This study, through the example of pediatric food-induced anaphylaxis, underlines the significance of compliance to guidelines, organized documentation in healthcare units using specially formulated medical history forms and continuous medical stuff training. Thus, diagnosis and treatment practices can be improved for the benefit of patients.

BackgroundDespite recent advances in implants and surgical techniques, catastrophic and clinical failures in the treatment of intertrochanteric fractures continue to occur, with dire consequences in an overall frail population subset. The aim of the current study is to evaluate the effect of the factors under the surgeons’ control, namely fracture reduction and implant selection, on the biomechanical behavior of fracture fixation constructs.Material-MethodsAn experimental protocol was conducted with the use of instrumented sawbones, in order to validate the finite element models. The implants used were the Gamma3®and DHS systems. Subsequently, a series of scenaria were considered, including various reduction and implant angle combinations. Data were retrieved concerning the peak cancellous bone stresses around the hip screw and the volume of cancellous bone in the femoral head stressed at critical levels …

Background The human microbiome is important due to the impact it has on host immunologic development and allergy-associated diseases. This study aimed to investigate the impact of prenatal exposure to antibiotics on the incidence of atopic dermatitis (AD) in children at 18 months of age. Methods Mothers were interviewed at baseline, in the maternity ward and by phone questionnaire after 18 months. Demographic data, mode of delivery, yoghurt consumption, antibiotic and other drug use during pregnancy, atopic history, diagnosis of AD and history of infections in the offspring were noted. Results 385 mothers were interviewed at baseline. 231 (60%) mothers with 236 children responded at follow up. Cesarean section was reported in 116 (50.2%) deliveries while antibiotic use during pregnancy in 55/231 (23.8%) women. 43/236 (18.22%) infants were diagnosed with AD. Intravenous antibiotic use was associated with a 7.7 increased risk of AD diagnosis in the offspring (95% CI 1.23-48.27, p= 0.029). An increased odd for AD was recorded for mothers 30-40 years of age (OR 4.50, 95% CI 1.08-18.7, p= 0.039). No significant association between cesarean section and AD (p= 0.70) was recorded. In multivariate analysis, reported food allergy (OR 8.03, 95% CI 2.30-27.97, p= 0.001) and otitis media episodes in children (OR 3.76, 95% CI 1.60-8.83, p= 0.002) were significantly associated with AD diagnosis. Conclusions An increased risk of AD was recorded only when antibiotics were given prenatally by intravenous route and in women between 30-40 years of age. Children with food allergy had an increased risk for AD. The relatively high …