Limassol, Cyprus
Limassol, Cyprus

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PubMed | Limassol General Hospital, Nicosia General Hospital, Frederick Research Center and King's College London
Type: | Journal: Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology | Year: 2016

A phantom assembly that simulates the respiratory motion of the heart was used to investigate artifacts and their impact on defect detection.SPECT/CT images were acquired for phantoms with and without small and large cardiac defects during normal and deep breathing, and also at four static respiratory phases. Acquisitions were reconstructed with and without AC, and with misalignment of transmission and emission scans. A quantitative analysis was performed to assess artifacts. Two physicians reported on defect presence or absence and their results were evaluated.All large defects were correctly reported. Attenuation reduced uptake in the basal LV walls, increasing FN physicians reports for small defects. Respiratory motion reduced uptake mainly in the anterior and inferior walls increasing FP and FN reports on images without and with small defects, respectively. Artifacts due to misalignment between CT and SPECT scans in normal breathing phantoms did not influence the physicians reports.Attenuation and respiratory motion correction should be applied to reduce artifacts before reporting on small defects in deep breathing conditions. Artifacts due to misalignment between CT and SPECT scans do not affect defect detection in normal breathing when the LV is co-registered in SPECT and CT images prior to AC.


Athanasiou Y.,Nicosia General Hospital | Voskarides K.,University of Cyprus | Gale D.P.,Imperial College London | Damianou L.,Limassol General Hospital | And 10 more authors.
Clinical Journal of the American Society of Nephrology | Year: 2011

Background and objectives Complement factor H and related proteins (CFHR) are key regulators of the alternative complement pathway, where loss of function mutations lead to a glomerulopathy with isolated mesangial C3 deposits without immunoglobulins. Gale et al. (12) reported on 26 patients with the first familial, hematuric glomerulopathy caused by a founder mutation in the CFHR5 gene in patients of Cypriot descent living in the United Kingdom. CFHR5 nephropathy is clinically characterized by continuous microscopic hematuria whereas some patients present with additional episodes of synpharyngitic macrohematuria, associated with infection and pyrexia. A subgroup of patients, particularly men, develop additional proteinuria, hypertension, and chronic renal disease or ESRD. Design, setting, participants, & measurements We herewith expand significantly on the study by Gale et al., reporting on histologic, molecular, and clinical findings in 91 patients from 16 families with the same founder mutation. Results Eighty-two patients (90%) exhibited microscopic hematuria; 51 (62%), exhibited only microscopic hematuria, whereas the remaining 31 additionally had proteinuria (38%); 28 proteinuric patients developed chronic renal failure (CRF). Among carriers of CFHR5 mutation aged >50 years, 80% of the men and 21% of the women developed CRF; 18 developed ESRD (14 men [78%], 4 women [22%]). Conclusions The diagnosis of CFHR5-related, isolated C3 glomerulopathy was established in 2009 using newly described mutation analysis after decades of follow-up with unclear diagnoses, occasionally confused with IgA nephropathy. This larger patient cohort establishes the clinical course, significant variable expressivity, and marked gender difference regarding the development of CRF and ESRD. © 2011 by the American Society of Nephrology.


Stavrinides P.,University of Cyprus | Constantinidou F.,University of Cyprus | Anastassiou I.,University of Cyprus | Malikides A.,Limassol General Hospital | Papacostas S.,Cyprus Institute of Neurology and Genetics
Epilepsy and Behavior | Year: 2012

This study investigated aspects of psychosocial adjustment in epilepsy patients in Cyprus. Sixty-three patients under 55. years of age with idiopathic or symptomatic epilepsy and 89 neurologically matched healthy volunteers participated. Subjects completed the State and Trait Anxiety Inventory and the Beck Depression Inventory; patients with epilepsy also completed the Epilepsy Foundation Concerns Index. Results showed that patients with symptomatic epilepsy had significantly higher scores on state and trait anxiety and depressive symptoms. Sociodemographic characteristics including gender, marital status, and education levels contributed to differences in trait and state anxiety, depressive symptom scales, autonomy concerns, and fear for seizure recurrence. Variables such as poor seizure control and use of polytherapy were associated with lower adjustment scores and reduced psychosocial outcome. Finally, patients with epilepsy scored significantly higher on depression and anxiety symptoms. The results provide further evidence on challenges patients with epilepsy face and on the need for implementing psychosocial prevention programs. © 2012 Elsevier Inc.


Voskarides K.,University of Cyprus | Arsali M.,Limassol General Hospital | Athanasiou Y.,Nicosia General Hospital | Elia A.,Archbishop Makarios III Hospital | And 2 more authors.
Pediatric Nephrology | Year: 2012

Background Familial hematuria (FH) is associated with at least two pathological entities: Thin basement membrane nephropathy (TBMN), caused by heterozygous COL4A3/ COL4A4 mutations, and C3 nephropathy caused by CFHR5 mutations. It is now known that TBMN patients develop proteinuria and changes of focal segmental glomerulosclerosis when biopsied. End-stage kidney disease (ESKD) is observed in 20% of carriers, at ages 50-70. A similar progression is observed in CFHR5 nephropathy. Recent evidence suggests that NPHS2-R229Q, a podocin polymorphism, may contribute to proteinuria in TBMN and to micro-albuminuria in the general population. Case-Diagnosis/Treatment NPHS2-R229Q was screened in a Cypriot FH cohort. 102 TBMN patients with three known COL4 mutations and 45 CFHR5 male patients with a single mutation were categorized as "Mild" or "Severe", based on the presence of microhematuria only, or proteinuria and chronic kidney disease. Nine R229Q carriers were found in the "Severe" category and none in the "Mild" (p00.010 for genotypic association; p00.043 for allelic association, adjusted for patients' relatedness), thus supporting the possible contribution of 229Q allele in disease progress. Conclusions Our results offer more evidence that in patients with FH, NPHS2-R229Q predisposes to proteinuria and ESKD. R229Q may be a good prognostic marker for young hematuric patients © IPNA 2011.


Tourvas A.-D.,Limassol General Hospital | Frangos C.C.,University College London
Medical Hypotheses | Year: 2011

Currently, carcinogenesis is considered to be the result of mal-expression of tumour suppressor genes and oncogenes, leading either way to uncontrollable and disorganized cell mitosis. Recently a novel class of genes has drawn the interest of the scientific community. These are microRNAs (miRNAs), a class of noncoding RNAs, 20-23 nucleotides in length, that can up or downregulate gene expression of downstream gene targets (including transcription factors, oncogenes, and tumour suppressor genes) at the post-transcriptional level. Some members of this new class of genes seem to have the potential to act simultaneously either as oncogenes or as tumour suppressor genes depending on the molecular microenvironment of the cell. We elaborate on this hypothesis by giving examples of miRNAs (e.g. mir- 9, miR- 17- 92) which seem to function by the abovementioned mechanism. This could mean that the deterministic notion of carcinogenesis as a result of merely tumour suppressor genes and oncogenes deregulation could be revised to contain the fact that certain members of this novel class of genes have the potential to play both roles simultaneously. © 2011 Elsevier Ltd.


PubMed | The Cyprus Institute of Neurology and Genetics and Limassol General Hospital
Type: Journal Article | Journal: European journal of nutrition | Year: 2016

Oxidative stress arises due to a cellular imbalance in oxidants and antioxidants and/or due to an altered activity of antioxidant enzymes, caused by SNPs. Oxidative stress increases susceptibility to breast cancer (BC) risk, and we previously showed that the Mediterranean diet (MD), which is rich in antioxidants, reduces BC risk in Greek-Cypriot women. Here, we investigated the effect of MnSOD (p.Val16Ala, rs4880) and CAT (-262C>T, rs1001179) SNPs on the association between the MD and BC risk in the case-control study of BC MASTOS in Cyprus.Dietary intake data were obtained using a 32-item food frequency questionnaire, from which a dietary pattern was previously derived, using principal component analysis. This pattern included high loadings of vegetables, fruit, legumes and fish, a combination that closely resembles the MD and was used as our dietary variable.High vegetable intake lowered BC risk in women with at least one MnSOD Val allele (ORHigh vs. Low for Val/Val=0.56, 95%CI 0.35-0.88, for Val/Ala=0.57, 95% CI 0.39-0.82), or one CAT -262C allele (ORHigh vs. Low for -262CC=0.66, 95% CI 0.47-0.92, for -262CT=0.53, 95% CI 0.35-0.81). High fish intake conferred a decreased BC risk of CAT -262CC women (ORQ4 vs. Q1 0.66, 95% CI 0.47-0.92) compared with the CAT -262TT women and low fish intake (ORQ2 vs. Q1 2.79, 95% CI 1.08-7.17). Additionally, high fish intake reduced BC risk in MnSOD Val/Val women (ORQ4 vs. Q1 0.63, 95% CI 0.40-0.98). p interaction values were, however, not statistically significant.Our results demonstrate that the antioxidative effects of the MD against BC risk may be enhanced by the wild-type alleles of the MnSOD or CAT SNPs among Greek-Cypriot women.


Andreou A.Y.,Limassol General Hospital
Cor et Vasa | Year: 2015

We present the case of a patient, in whom coronary angiography performed for non-ST-segment elevation myocardial infarction five months after coronary artery bypass graft surgery disclosed a tight stenosis with superimposed diastolic compression in the proximal segment of a saphenous vein graft (SVG) to a diagonal artery. Furthermore, the SVG segment immediately distal to the stenosis exhibited obstructive dynamic compression during diastole. Stent implantation across the proximal stenosis was undertaken successfully with a consequent resolution of the dynamic downstream stenosis. This is the third case of diastolic segmental SVG compression not related to pericardial constriction ever reported in the English literature and the first case where implantation of a balloon-expandable stent was performed in an SVG to treat a significant organic stenosis with superimposed diastolic compression. We discuss the pathophysiologic characteristics of this case and the potential clinical utility of the current stent platforms to adequately scaffold such dynamic lesions. © 2015 The Czech Society of Cardiology.


Malas S.,Limassol General Hospital
Journal of Pediatric Hematology/Oncology | Year: 2011

The oncology and palliative care services in Cyprus were reviewed looking especially on changes that occurred recently. Although there are encouraging signs in the management of palliative care patients, there is still room for improvement. Especially efforts should be made to improve communication between hospitals and palliative care organizations. The Ministry of Health should also take the initiative to get all palliative care organizations to work together under an official body and integrate palliative care into mainstream health service provision and education. Copyright © 2011 by Lippincott Williams & Wilkins.


Epstein-Barr virus (EBV)-related haemophagocytic lymphohistiocytosis (EBVr-HLH) has a better prognosis when the virus is rapidly cleared, but the best antiviral approach is controversial. We present a patient to whom the therapeutic standard rituximab was co-administered with valacyclovir and an HLH-specific treatment with favourable viral and clinical responses. We conducted an extensive literature review and contacted several world reference centres and experts to inquire about their approaches and experience. We conclude that antivirals are infrequently used for EBVr-HLH, despite their laboratory-proven and likely clinical beneficial effect on some EBV-related diseases. However, the role of antivirals remains obscure. Concerns about their lack of efficacy are based on observational data and reports of the cellular tropism of EBV. Therefore, the adjunct use of antivirals may be considered when myelotoxicity is not the primary concern, and related outcomes should be systematically recorded to produce higher quality evidence.


PubMed | Limassol General Hospital
Type: | Journal: BMJ case reports | Year: 2016

Any advanced shock eventually degenerates into vasoplegia, which responds weakly to vasopressors. The highest reported norepinephrine flow rate is 3g/kg/min. We present the case of a young explosion victim, who was transferred in late haemorrhagic shock. Apart from usual treatment (hydration, mass transfusion protocol), single-agent norepinephrine was used to maintain a mean arterial pressure (MAP) of >60-65mmHg. For several hours, norepinephrine flow was 7-10 times the aforementioned (highest reported) in order to achieve our goal; during which, further hydration or transfusion would not contribute to MAP elevation. Sequential Organ Failure Assessment (SOFA) severity score was 18 (expected mortality >99%). The patient survived without underperfusion-related damage. We conclude that norepinephrine dosages could potentially be greatly increased in late shock. We must resist giving up flow escalation based on its numerical value.

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