Petros Skepastianos

Objectives: Myelodysplastic syndromes (MDSs) are a heterogeneous group of clonal hematopoietic disorders characterized by ineffective hematopoiesis, genomic instability, and a high risk of progression to acute myeloid leukemia. Oxidative stress (OS) has emerged as a central factor in MDS pathophysiology, contributing to DNA damage, altered cellular signaling, and disease progression. Recent advances in artificial intelligence (AI) and machine learning (ML) offer a transformative approach for integrating multidimensional datasets including oxidative stress markers, hematologic parameters, and molecular profiles to enhance diagnosis, prognostication, and therapeutic monitoring in MDS. Methods: A comprehensive literature search was conducted in PubMed and Scopus, using the keywords “OS biomarkers,” “AI,” and “MDS’’. Results: Modified redox biomarkers can be correlated with oxidative imbalance and disease progression. ML models such as neural networks, decision trees, and support vector machines effectively capture complex relationships among redox biomarkers, enhancing risk stratification and prediction of treatment response. AI-driven proteomic analyses further revealed OS-related protein signatures linked to MDS pathophysiology. Overall, AI and ML enable the transformation of multidimensional OS data into clinically actionable tools for personalized management in MDS. Conclusions: Integrating biomarker research with AI-based analytics holds promise for advancing personalized diagnostics, prognostication, and therapeutic strategies in MDS, paving the way toward precision medicine.

Background/Objectives: To evaluate the association between adjunct tendon vibration and changes over 12 months in dual-energy X-ray absorptiometry (DXA)-derived bone mineral density (BMD) T-score and bone turnover markers in older adults with osteoporosis receiving standard care in a non-randomised controlled cohort study. Methods: This 12-month prospective non-randomised controlled cohort study included 100 adults aged ≥60 years with DXA-confirmed osteoporosis recruited from orthopaedic clinics in the Greater Thessaloniki area. Fifty participants received adjunct tendon vibration therapy in addition to usual care, while 50 received usual care alone. Usual care consisted of calcium and vitamin D supplementation. The primary outcome was post-intervention BMD T-score, analysed using analysis of covariance (ANCOVA) adjusted for baseline T-score. Secondary outcomes included changes in bone turnover markers and calcium/phosphate metabolism. Sensitivity analysis was conducted using a linear mixed-effects model with repeated BMD measurements. Results: Baseline characteristics were comparable between groups. Over 12 months, the intervention group showed greater improvement in BMD T-score than controls (median change 0.90 [0.70–1.00] vs. −0.10 [−0.10–0.10], p < 0.001). The adjusted between-group difference was 0.871 (95% CI 0.773–0.968; p < 0.001). Results remained consistent after adjustment for age and sex. The mixed-effects model confirmed a significant group × time interaction (β = 0.922, 95% CI 0.806–1.038; p < 0.001). Bone resorption markers decreased more in the intervention group. The magnitude of the observed BMD improvement (~0.9 T-score units) is notable for a non-pharmacological intervention and should be interpreted cautiously. Conclusions: Adjunct tendon vibration was associated with a more favourable BMD trajectory and changes in bone turnover markers in older adults with osteoporosis receiving standard care. Given the non-randomised design and potential residual confounding, these findings should be interpreted as associative rather than causal.

Objectives: The aim of this study was to assess nutrient intake among individuals adhering to the Christian Orthodox Church (COC) fasting and to investigate potential differences in dietary intake according to Body Mass Index (BMI) classification. Methods: This cross-sectional study enrolled participants through announcements at public universities, churches, and monasteries, targeting both urban and religious adult populations. A total of 228 adults with a BMI exceeding 25 kg/m² were enrolled. Of these, 121 had followed COC fasting practices for at least 10 years or since childhood, while 107 non-fasters were age-matched. Exclusion criteria included age under 18 years, refusal to provide consent, absence from measurements, non-communicable diseases, food allergies, pregnancy, or lactation. Results: Overweight and obesity rates were similar in both groups. Furthermore, there were no statistically significant differences in body composition measurements [body fat %, fat mass (kg), fat free mass (kg), waist circumference]. Diastolic and systolic blood pressure was significantly higher in non-fasters. Non-fasters reported higher intake of sugar, dietary protein, fats (saturated and polyunsaturated), and cholesterol. Fasters consumed lower amounts of vitamin A, vitamins B (B2, B3, B6, B12, folate, pantothenic acid), iron, phosphorus, sodium, zinc, and calcium. Serum folic acid levels were higher, and fasting glucose and phosphorus levels were lower in fasters. Distinct dietary patterns were observed between groups, with fasters consuming more fish and traditional plant-based foods, while non-fasters consumed higher amounts of meat, dairy products, and alcohol. Conclusions: COC fasting is associated with favorable dietary and metabolic profiles, including improved glucose regulation. However, its impact on weight status appears limited.

The efficient and targeted delivery of pharmaceutical substances remains a major challenge in modern therapeutics. Traditional drug delivery systems often suffer from limited bioavailability, rapid clearance, and off-target effects. Red blood cells (erythrocytes), due to their long circulation time, biocompatibility, and immune-evasive properties, have emerged as promising carriers in the development of novel nanotechnology-based drug delivery platforms.A comprehensive literature review was conducted, analyzing recent studies on erythrocyte membrane-coated nanoparticles, their interactions with loaded therapeutic agents, and their performance in vitro and in vivo. Special focus was given to applications in chemotherapy, photodynamic therapy (PDT), photothermal therapy (PTT), and immunotherapy. Erythrocyte-based nanocarriers demonstrated improved circulation times, reduced immune clearance, and enhanced targeting capabilities compared to traditional nanoparticles. Encapsulation of nanoparticles within erythrocyte membranes preserved the functional integrity of the carrier while minimizing systemic toxicity. However, challenges such as membrane stability, hemocompatibility, and the potential for nanoparticle-induced hemoglobin dysfunction were identified as areas requiring further research. In conclusion, erythrocyte membrane-coated nanoparticles represent a unique and promising strategy for drug delivery, combining the natural advantages of red blood cells with the versatility of nanotechnology.

The positive effects of the Mediterranean diet on healthy living are widely known, while the health effects of religious fasting have received increased attention during the last decade. However, no study has focused on the consumption of ultra-processed foods (UPFs) in such populations. Therefore, our aim was to investigate UPF intake and its association with metabolic syndrome (MetS) in a Christian Orthodox church (COC) religious fasting population in Greece. In this cross-sectional study, 400 individuals who follow the Mediterranean diet were included, stratified as COC fasters and non-fasters. Dietary intake data were collected via three 24 h diet recalls and a monthly food frequency questionnaire (FFQ). The NOVA food classification system was used to identify the level of processing and categorize all food items. Fasters consumed significantly less chicken, turkey, and beef and significantly more seafood, fish, snails, soy products, and fresh fruits, in terms of unprocessed or minimally processed foods, as well as significantly more fried potatoes and olives in terms of processed foods when compared with non-fasters. Regarding UPFs, a significantly lower intake of pork sausages, ketchup, and mustard as well as a significantly higher consumption of margarine and tarama dip were recorded in fasters compared with non-fasters. Fasters with MetS more frequently consumed UPFs (such as cheese pastries, biscuits, and cakes) than fasters without MetS (p < 0.05 for all comparisons). Similarly, non-fasters with MetS had an increased intake of UPFs (such as Cypriot bread and Coco Pops breakfast cereals) than non-fasters without MetS. Future research should focus on UPF consumption and its associations with clinical outcomes in such populations, thus providing further data for the potential health effects of COC fasting.

The association between salt-related knowledge, attitude, behaviour (KAB) and actual salt consumption in Greek adults is uncertain. This study investigates the correlation between salt intake, gauged by 24-h urinary sodium excretion, with salt-related KAB. It further explores how socio-demographic factors influence these behaviors. Salt consumption was evaluated using a 24-h urinary sodium test, and compared to self-reported KAB data. Knowledge and behavior scores related to salt were computed. An overall cohort-adjusted model examined the relationship between daily salt consumption, knowledge and behavior scores, and certain covariates. Through the stratification by the cohort random effect, two models were established (Cohort I Adults; Cohort II Students) examining the same relationships of the overall cohort model. 463 Greek adults participated. The average salt intake was 9.54 g/day, nearly double the WHO recommendation. Significant differences in knowledge scores were noted based on sex, age, education, and BMI. A trend suggesting lower discretionary salt use with increased salt intake was observed (p = 0.06). However, comprehensive analysis revealed no direct correlation between salt intake and either knowledge (p = 0.562) or behavior scores (p = 0.210). The results emphasize the need for food product reforms by industry stakeholders and accelerated efforts towards reducing salt intake.

It is well known that the Mediterranean diet contributes to healthy living, prevention of non-communicable diseases, and longevity. A cross-sectional study was conducted with participants from Greece who follow the Mediterranean diet and were further divided into two categories: (i) Christian Orthodox Church (COC) religious fasters and (ii) non-fasters. Four-hundred individuals underwent anthropometric measurements, whereas information regarding dietary intake was collected via three 24 h diet recalls and a monthly food frequency questionnaire. Principal component analysis was performed to derive dietary patterns, whereas associations between dietary patterns and metabolic syndrome (MetS) risk factors were investigated with the general linear model. Non-fasters (n = 200) were found to consume significantly more beef, chicken, turkey, sausage, broth, fried potatoes, ketchup, and mustard, while consuming less seafood, snails, soya, tarama salads, fresh fruits, margarine, olives, and decaf coffee. Two distinct dietary patterns were identified in fasters: (i) the “Mixed Diet” and (ii) the “Plant-based/Fasting Diet” pattern. Moreover, three patterns were identified in non-fasters, and were identified as follows: (i) the “Western Diet”, (ii) the “Mixed Diet”, and (iii) the “Mediterranean-like Diet” pattern. No significant association was observed between dietary patterns and the prevalence of MetS in our population. Further epidemiological studies should evaluate the links between dietary patterns and MetS prevalence within the adult Greek population.

Objective: The Christian Orthodox Church (COC) fasting is a periodic vegetarian-type diet lasting 180–200 days annually in which seafood and snails are allowed on all fasting days. Our aim was to investigate the effects of COC fasting on metabolic syndrome (MetS) in adults >50 years. Methods: One hundred seventy-six individuals participated in the study (mean age 59.7 ± 6.0 years). Eighty-nine had been following the COC fasting regime since their childhood and eighty-seven were non-fasters. Anthropometric measurements, blood samples, and nutrient intake data were collected at a scheduled appointment, during a non-fasting period. Results: Fasters had significantly higher hip circumference (102 ± 8.5 vs. 98.8 ± 7.5 cm, p = 0.009), low-density lipoprotein (LDL) cholesterol (136 ± 73 vs. 115 ± 51 mg/dL, p = 0.033), and folic acid levels (6.0 ± 4.0 vs. 3.0 ± 1.2 ng/mL, p = 0.018), as well as lower systolic blood pressure (SBP) (131 ± 13 vs. 136 ± 14 mmHg, p = 0.045), diastolic blood pressure (DBP) (80 ± 8 vs. 83 ± 7 mmHg, p = 0.007), glucose (87 ± 16 vs. 93 ± 25 mg/dL, p = 0.039), and triglycerides (143 ± 94 vs. 175 ± 84 mg/dL, p = 0.040). Fasters had significantly less intake of calories (1493.65 ± 363.74 vs. 1614.65 ± 426.28 kcal, p = 0.044) and fat (81.17 ± 25.47 vs. 90.74 ± 24.75 g, p = 0.012), whereas they also consumed significantly less vitamin A-retinol, vitamin B2, vitamin B12, vitamin E, folic acid, pantothenic acid, calcium, phosphorus, zinc, and significantly more vitamin C (p < 0.005 for all comparisons). BP was significantly higher in non-fasters (44.8 vs. 22.5%, p = 0.002), whereas MetS was more frequently present in non-fasters vs. fasters, with a marginal level of significance (35.6 vs. 22.5%, p = 0.055). Conclusions: COC fasting may affect beneficially MetS prevalence in individuals >50 years, although future research is needed before reaching definite conclusions.

Religious fasting that involves abstinence from specific food(s) is part of many religions worldwide and has been gaining attention by the research community during the last years. The study aimed to investigate whether the periodic Christian Orthodox fasting mitigates the changes in body composition, dietary intake, and metabolic syndrome (MetS) in postmenopausal women. One hundred and thirty-four postmenopausal women aged 57.3 ± 6.7 years participated in this study. The Christian Orthodox fasting was followed by 68 postmenopausal women since their childhood, whereas 66 postmenopausal women were non-fasters. Data collection involved anthropometric, biochemical, clinical, and dietary information. Postmenopausal women who fasted according to Christian Orthodox Church recommendations had significantly higher mean fat free mass (45 vs. 44 kg, p = 0.002), hip circumference (104 vs. 99 cm, p = 0.001), and diastolic blood pressure (79 vs. 82 mmHg, p = 0.024). No other differences were found with regards to anthropometric data. Fasters also consumed significantly less fat (78 vs. 91 g, p = 0.006), as well as saturated (19 vs. 23 g, p = 0.015), monounsaturated (41 vs. 47 g, p = 0.018), and polyunsaturated fat (8.5 vs. 10 g, p = 0.023), trans fatty acids (0.5 vs. 2.3 g, p = 0.035), and cholesterol (132 vs. 176 g, p = 0.011). In terms of MetS features, non-fasters had more frequently elevated fasting blood glucose (11.8 vs. 24.2%, p = 0.039) and elevated blood pressure (13.2 vs. 36.4%, p = 0.041) compared with fasters. MetS was more common in non-fasters versus fasters with a marginal level of significance (30.3 vs. 23.5%, p = 0.052). Postmenopausal women who follow the Christian Orthodox fasting regime had lower fat intake, and no other difference in nutrient intake, compared with non-fasters. The latter were more likely to have MetS and some of its components. Overall, periodic abstinence from meat, dairy products, and eggs might play a protective role in postmenopausal women with regard to MetS.

Objective: Studies regarding health effects of religious fasting have been increased during the last decade. Our aim was to investigate the impact of adherence to the periodic Christian Orthodox Church (COC) fasting on nutrient intake, body composition, and risk factors for metabolic syndrome (MetS). Methods: Four-hundred individuals aged 42.6 ± 17.0 years participated in this cross-sectional study. Two-hundred subjects followed the COC fasting since childhood or at least the last twelve consecutive years, and two-hundred subjects did not follow the COC fasting regimes or any other restrictive dietary pattern. Socioeconomic data, lifestyle habits, and physical activity data were collected. Nutritional assessment was performed via two 24 h recalls and a food frequency questionnaire. Anthropometric data and biochemical parameters were also measured. Results: Fasters had a significantly lower daily intake of calories (1547 vs. 1662 kcals, p = 0.009), protein (52 vs. 59 g, p = 0.001), fat (82 vs. 89 g, p = 0.012), and cholesterol (147 vs. 178 g, p = 0.001) compared with non-fasters. Furthermore, fasters reported a healthier way of living, with lower rates of smoking and alcohol consumption (p < 0.001 and 0.002, respectively). Insulin and magnesium levels were significantly higher, whereas levels of urea, transaminases, glucose, and phosphorus were significantly lower, as was DBP in fasters versus non-fasters. Furthermore, MetS prevalence was non-significantly higher in non-faster compared with fasters. Conclusion: During a non-fasting period, individuals following the COC fasting recommendations reported lower intake of calories, protein, fat, and cholesterol compared with non-fasters. Fasters tended to have a healthier lifestyle pattern and a lower risk for MetS versus non-fasters. Some biochemical parameters also significantly differed between the two study groups. Further research is warranted to establish the long-term clinical impact of these findings.