Afroditi Boutou

Background: We conducted a systematic review and meta-analysis to compare functional and hemodynamic parameters between patients with Meth-APAH and idiopathic PAH (IPAH). Methods: MEDLINE, Scopus, and gray literature were searched up to September 2025. Eligible studies were observational and compared functional and hemodynamic parameters between patients with Meth-APAH and IPAH. All participants had undergone diagnostic right heart catheterization (RHC) and were classified by methamphetamine use history and/or toxicological screening. Primary outcomes included World Health Organization Functional Class III or IV (WHO-FC III/IV), six-minute walk distance (6-MWD), and mean pulmonary arterial pressure (mPAP). Secondary outcomes were cardiac index (CI), right atrial pressure (RAP), pulmonary vascular resistance (PVR), stroke volume index (SVI), pulmonary artery wedge pressure (PAWP), and heart rate (HR). Random-effects models were applied for pooled estimates. Results: Five studies comprising 1991 participants were included. Patients with Meth-APAH demonstrated a significantly higher risk of being classified as WHO-FC III/IV (RR 1.17, 95%CI 1.05–1.30, p = 0.01), as well as higher RAP (MD 1.59, 95%CI 0.07–3.11, p = 0.04) and reduced SVI (MD −3.57, 95%CI −6.74–−0.4, p = 0.04), but differences were modest. No significant differences were found for 6-MWD, mPAP, CI, PVR, PAWP, or HR. Conclusions: Meth-APAH could be associated with worse functional and hemodynamic profile compared to IPAH, but available studies are few with high heterogeneity, so that clear differences in several functional and hemodynamic parameters could not be established between these disease entities. These results highlight the need for further research in this direction.

Pulmonary hypertension (PH) is a progressive, multifactorial syndrome characterized by elevated pulmonary arterial pressure and right heart dysfunction, associated with significant morbidity, impaired quality of life, and poor prognosis. Advances in classification, hemodynamic definitions, and targeted pharmacotherapies have improved understanding and management, yet therapeutic challenges persist across the five World Health Organization groups of PH. Historically, exercise was discouraged due to concerns about adverse hemodynamic effects, but growing evidence has suggested that structured, supervised training is safe and beneficial. Randomized trials and meta-analyses show improvements in six-minute walk distance, peak oxygen uptake, right ventricular function, ventilatory efficiency, and health-related quality of life, with a low incidence of adverse events. Physiological adaptations include favorable cardiac remodeling, enhanced endothelial function, improved skeletal and respiratory muscle performance, and improved neurohormonal activity. Despite this evidence, barriers such as patient fears, limited clinical expertise, and restricted access to specialized rehabilitation programs hinder widespread implementation. Current guidelines recommend supervised exercise as part of pulmonary rehabilitation for patients with stable PH, supporting its role as an adjunct to pharmacotherapy. This descriptive review briefly summarizes the pathophysiology of PH, phenotype-related differences and current therapeutic approaches, and the beneficial adaptations to exercise training, with the aim of informing exercise specialists and supporting safer, more effective integration of exercise-based rehabilitation into patient care.

Tuberculosis remains the world’s top fatal infectious disease, causing more than 1.5 million deaths globally annually, especially in low and/or middle-income countries. Greece, although still considered to be a low prevalence country according to the National and Global Report data, has experienced an epidemiological rise in the post covid era. A major limitation in the identification of the true epidemiological burden is the underreporting, especially of probable cases. The aim of this 4-year retrospective, epidemiological study was to record all newly diagnosed patients with active tuberculosis in a large, tertiary hospital of Northern Greece with their epidemiological and clinical characteristics. The temporal trend of newly diagnosed cases was identified and compared with the reports of the corresponding National Surveillance data. A total of 45 patients were identified with active tuberculosis in the years 2022-2025 with a mean symptom duration of 45 days prior to diagnosis. The patients were mostly adults (≥18 years, 74%), male (66%), of 39 years median age, and 67% natives, of Greek origin. In 38% of the patients the manifestations were exclusively extrapulmonary, more frequently so in the native population. Three strains (6,6%) were rifampicin resistant. This real-world epidemiological study provides a direct reflection of the presentation and prevalence of tuberculosis in the community, describes the clinical spectrum and the available diagnostic approaches, and identifies potential weaknesses of the Health Surveillance system.