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Biomedical subjects

V Kyriazopoulou

Publications and source records attributed to V Kyriazopoulou.

18 recordsLinked to original sources

Greek measles epidemic strain, 2005-2006.

The purpose of this work was the molecular study of the virus strain that caused the last measles outbreak in Greece. Twenty-four saliva specimens were obtained from selected patients serologically confirmed as measles cases between December 2005 and March 2006. Measles virus (MV) detection was performed by a nested RT-PCR. The 447-bp segment of the N gene of these MV strains was used for genotyping. The N gene sequences of the Greek MV strains were identical to each other, therefore a phylogenetic tree was constructed using one representative MV (ThesGRE/06). Our data show that the MV strain which caused the 2005-2006 outbreak in Greece belongs to genotype D6, and differs by 0.68% from the New Jersey D6 strain and by 5.5% from the MV vaccine strain Edmonston B (U03656) belonging to genotype A.

Adult↗

Prolactin, cortisol secretion and thyroid function in patients with stroke of mild severity.

Different attempts were made to identify the variables that may be involved in the clinical course of cerebrovascular ischemia. In the case of stroke with mild severity (SMS), the clinical significance of neuroendocrine changes as well as of post-stroke depression (PSD) remains unknown. We therefore evaluated the presence of neuroendocrine changes in the acute and post-acute phase of SMS, and their potential role during convalescence. Serum cortisol, T4, T3, FT4, FT3, TSH and PRL levels were measured in 17 euthyroid patients with stroke on admission (day 1), following morning (day 2), 7 days and 3 months later. TSH and PRL secretion after TRH test were measured. Stroke severity on admission was determined by Scandinavian Stroke Scale (SSS). Montgomery-Asberg Depression Rating Scale (Madrs) was used for assessment of post-stroke depression. On admission, TSH and T3, were within normal limits and were greater compared to values on day 2. Lower basal TSH and decreased TSH response to TRH on day 2, were associated with stroke of greater severity. Delta-PRL after TRH on day 2 was higher in patients who develop PSD. Changes in serum thyroid hormones in SMS, reflects those of non-thyroidal illness. A mild stimulation of hypothalamic-pituitary-adrenal axis was detected. We provide evidence that PRL response to TRH, in the acute phase of stroke may be used as an index for early detection of PSD.

Aged↗

A pseudo-outbreak of human A/H5N1 infections in Greece and its public health implications.

The recent wide geographic spread of the highly pathogenic avian influenza A/H5N1 virus has important public health implications. Several wild migratory birds were confirmed to be infected with avian influenza A/H5N1 in Greece in February and March 2006. The aim of this paper is to report data from potential H5N1 human cases that presented to local hospitals during this period with a respiratory infection and expressing concern about exposure to avian influenza. A case-control investigation was conducted that included case identification with the use of a structured definition, review of epidemiological and clinical characteristics and molecular testing for avian influenza A/H5N1. The setting was the entire country of Greece during February and March 2006. The main outcomes were rates of possible cases (meeting both a clinical and an epidemiological criterion) and clinical or epidemiological characteristics differentiating them from potential cases that met either one of the criteria of a possible case, but not both. Twenty six potential patients (81% of whom met a clinical criterion, and 39% of whom met an epidemiological criterion) presented and most (85%) were admitted in local hospitals during the period of interest. The majority of cases (85%) were observed in northern Greece where most of the confirmed A/H5N1 avian cases were documented. Five of the 26 evaluated patients met the definition of a possible case. These clustered within the early period of confirmed A/H5N1 cases in wild migratory birds (P=0.05). Molecular testing was negative for all possible cases. Application of a revised case definition constructed according to newer European Union guidance resulted in the exclusion of two possible cases. Several potential A/H5N1 human cases were recently identified in Greece. Both the timing of identification and the geographical location of potential cases suggest an increased awareness on the part of the general public, as well as poor interpretation of the case definition by the clinicians.

Adolescent↗

Real or media-mediated outbreak of coxsackie infections in 2002 in Greece?

The purpose of this study was to provide evidence about the existence of a coxsackie B outbreak in Greece in 2002 by comparing data of laboratory confirmed coxsackie B recent infections in northern Greece between 1998-2001 with data from 2002. The infections were confirmed serologically, using the indirect immunofluorescence method detecting IgM antibodies for coxsackie B1-B6 viruses. Sera from 2701 patients residents of northern Greece who were suspected to be suffering from coxsackie B virus infections were examined: 2056 between 1998 and 2001, and 645 in 2002. The comparison between the results of laboratory confirmed cases and data available at the laboratory between the two periods showed that: The total number of patients examined per year was higher in 2002 (645 versus an annual average of 514 in 1998-2001). The proportion of laboratory confirmed recent infections was lower in 2002 (27.8% versus 32.7%) and the estimated incidence was 0.66/10,000 for 2002 and 0.32-0.84/10,000 for 1998-2001. The age distribution differed: the proportions of cases in children versus cases in adults were reversed in 2002 compared with 1998-2001, with a higher proportion among children in 2002. The difference between the two periods was statistically significant. Children aged 3-5 years were the age group most affected in 2002. Seasonal distribution remained the same for both periods (peaks in spring and autumn). In 2002, three fatal cases occurred in April, but no deaths were reported in 1998-2001. The clinical syndromes involved also differed: cases of respiratory infections, mainly pneumonia, rose from 5.75% to 24.3% in children in 2002 and cases of myopericarditis rose in adults from 13% in 1998-2001 to 29.5% in 2002. The last finding, combined with the involvement of the media (because of the three fatal cases) and the panic in the general public that followed suggested that an outbreak had occurred, but we conclude that there was no outbreak.

Adolescent↗

Impairment of erythrocyte viscoelasticity is correlated with levels of glycosylated haemoglobin in diabetic patients.

Erythrocytes from diabetic patients exhibit impaired viscoelastic properties when estimated by various methods. We determined erythrocyte filterability through 5-microm pores, in 51 patients with non-insulin-dependent diabetes mellitus, 18 healthy controls, 15 patients with homozygous beta-thalassemia and 15 with beta-thalassemia traits. The filtration measurements were made with a Hemorheometer, which uses the "initial flow rate" principle. To determine the Index of Rigidity (IR) of the red blood cells, we measured the passage time of white blood cell-free erythrocyte suspensions, 8% per volume, through the filter. Diabetic patients had significantly increased IR in comparison to healthy controls and to patients with beta-thalassemia trait, but not at the level found in patients with homozygous beta-thalassemia. In diabetic patients, a strong correlation between IR and the percentage of glycosylated haemoglobin was found (r=0.737, P < 0.0001), and a weaker one with serum unconjugated bilirubin (r=0.363, P=0.0097) and serum total lipids (r=0.321, P=0.0286). Patients with severe retinopathy also had significantly increased IR, in comparison to those with or without mild retinopathy. Anaemic diabetic patients, especially those with the anaemia of chronic disease, also had significantly increased IR in comparison to non-anaemic diabetics. No correlation between IR, MCV, MCH, MCHC, RDW, RBC morphology, serum LDH or the presence of erythrocyte inclusions after incubation with nitrous sodium solution was found. Our findings suggest that glycosylation of skeletal proteins probably contributes significantly to the increased membrane rigidity of diabetic erythrocytes.

Diabetes Mellitus, Type 2↗

Iodine-Induced hypothyroidism.

Iodine is an essential element for thyroid hormone synthesis. The thyroid gland has the capacity and holds the machinery to handle the iodine efficiently when the availability of iodine becomes scarce, as well as when iodine is available in excessive quantities. The latter situation is handled by the thyroid by acutely inhibiting the organification of iodine, the so-called acute Wolff-Chaikoff effect, by a mechanism not well understood 52 years after the original description. It is proposed that iodopeptide(s) are formed that temporarily inhibit thyroid peroxidase (TPO) mRNA and protein synthesis and, therefore, thyroglobulin iodinations. The Wolff-Chaikoff effect is an effective means of rejecting the large quantities of iodide and therefore preventing the thyroid from synthesizing large quantities of thyroid hormones. The acute Wolff-Chaikoff effect lasts for few a days and then, through the so-called "escape" phenomenon, the organification of intrathyroidal iodide resumes and the normal synthesis of thyroxine (T4) and triiodothyronine (T3) returns. This is achieved by decreasing the intrathyroidal inorganic iodine concentration by down regulation of the sodium iodine symporter (NIS) and therefore permits the TPO-H202 system to resume normal activity. However, in a few apparently normal individuals, in newborns and fetuses, in some patients with chronic systemic diseases, euthyroid patients with autoimmune thyroiditis, and Graves' disease patients previously treated with radioimmunoassay (RAI), surgery or antithyroid drugs, the escape from the inhibitory effect of large doses of iodides is not achieved and clinical or subclinical hypothyroidism ensues. Iodide-induced hypothyroidism has also been observed in patients with a history of postpartum thyroiditis, in euthyroid patients after a previous episode of subacute thyroiditis, and in patients treated with recombinant interferon-alpha who developed transient thyroid dysfunction during interferon-a treatment. The hypothyroidism is transient and thyroid function returns to normal in 2 to 3 weeks after iodide withdrawal, but transient T4 replacement therapy may be required in some patients. The patients who develop transient iodine-induced hypothyroidism must be followed long term thereafter because many will develop permanent primary hypothyroidism.

Amiodarone↗

Dissociation of the early decline in serum T(3) concentration and serum IL-6 rise and TNFalpha in nonthyroidal illness syndrome induced by abdominal surgery.

The etiology of the prompt decline in serum T(3) in patients with nonthyroidal illness syndrome has not been adequately explained. It has been attributed to various parameters, including test artifacts, inhibitors of T(4) and T(3) binding to proteins, decreased 5'-deiodinase activity, and circulating cytokines. Currently, much attention is centered on the role of IL-6 and TNFalpha in developing the nonthyroidal illness syndrome through an effect on the hypothalamus, pituitary, and possibly 5'-deiodinase activity. We therefore studied the relation of the endogenous serum IL-6 and TNFalpha rise early in the course of nonthyroidal illness syndrome to the early decline in serum T(3) in 19 apparently healthy individuals, aged 43 +/- 16 yr, who underwent elective abdominal surgery for cholelithiasis or gastroplasty. Serum T(3), free T(3), T(4), free T(4), rT(3), TSH, IL-6, and TNFalpha were measured before and at various time intervals up to 42 h after skin incision. We observed a prompt decline in serum T(3) 30 min before skin incision, which continued to decline throughout the observational period. The magnitude of the decline reached 20% from the baseline value at 2 h. The early decline of T(3) was attenuated and lasted from the 2-8 h, probably due to the sharp increase in serum TSH that started immediately after the entrance to the operating room and lasted for 2 h. In contrast, serum T(4) and free T(4) concentrations were increased soon after skin incision and remained elevated during the first postoperative day. Serum rT(3) increased approximately 6 h after the initiation of surgery and remained elevated thereafter. Serum IL-6 remained essentially undetectable for 2 h after skin incision, whereas serum T(3) was low. Two hours after skin incision, serum IL-6 increased sharply and remained elevated throughout the observational period. Serum TNFalpha remained essentially undetectable throughout the postoperative period. Serum cortisol increased rapidly upon entrance to the operating room and remained elevated throughout the postoperative period. We conclude that the decline in serum T(3) early in the course of nonthyroidal illness syndrome is not due to increased serum IL-6 or TNFalpha levels. The brisk TSH secretion soon after the onset of the syndrome attenuates the decline in serum T(3) due to T(3) secretion from the thyroid. The early and brisk cortisol response to surgery may at least in part explain the early decrease in serum T(3) in nonthyroidal illness syndrome.

Abdomen↗

Medial arterial calcification is frequently found in patients with microalbuminuria.

The presence of medial arterial calcification (MAC), often referred to as Moncheberg's sclerosis, was sought in patients with long-standing diabetes mellitus. One hundred patients aged 22-50 years were initially divided into two groups, those with neuropathy and those without. As expected, the incidence of MAC was significantly higher in the neuropathy group (40% vs. 20%). When the patients were divided into two groups, those with MAC and those without, it appeared that the incidence of MAC was very high in patients who had microalbuminuria (57% vs. 13%) and particularly when microalbuminuria was combined with neuropathy (40% vs. 7%). It is concluded that microalbuminuria is a strong predicting factor of medial arterial sclerosis independent of neuropathy.

Adult↗

Human parvovirus B19: immunity of Greek females and prenatal investigation of hydrops fetalis.

Sera from 308 healthy Greek females of reproductive age were examined for specific IgG antibodies to human parvovirus B19 by recombinant-Elisa to determine the immunity rates of this part of population to parvovirus B19. Also paired maternal sera and amniotic fluids from nine pregnancies with hydrops fetalis were investigated for specific IgG and IgM antibodies and parvovirus DNA by polymerase chain reaction and southern hybridization analysis. The latter study was conducted to find out the participation of parvovirus B19 infection in hydrops fetalis cases in Greece. The overall prevalence of IgG antibodies in healthy Greek females was at a rate of 57.8% rising with age. One case of hydrops fetalis out of the nine examined, was diagnosed prenatally as parvovirus B19 maternal-fetal infection. It was a twin pregnancy with one fetus hydropic and the other growth retarded. Premature birth of liveborn infants was followed by neonatal death, 48 h after delivery. The contribution of parvovirus B19 in cases of non-immune hydrops fetalis was at 11% in this part of the world.

Adult↗

Serological survey on the immunity to diphtheria of the northern Greek population.

The recent outbreak of diphtheria in the Newly Independent States (NIS) of the former USSR and the immigration from these high risk areas to Greece prompted us to determine the diphtheria antitoxin levels by enzyme-linked immunosorbent assays (ELISA) in 509 healthy individuals (307 males and 202 females) from northern Greece. The population under study was divided in ten age groups from 1 day to > 60 years old. Diphtheria antitoxin levels of > or = 0.1 IU/ml were considered as protective ones. 44.6% of the examined people were found susceptible. The children up to their twenties seem to be immune to diphtheria in a high proportion (86-88.4%). The diphtheria antitoxin levels declined sharply above this age (17.6% in the age group 21-30 years old). The level of protection in adults appeared to be higher in the oldest group (49%). According to these results, the adults are not properly protected. Booster doses of vaccine for them are recommended to improve the resistance of the northern Greek population from possible infection by toxigenic stains of Corynebacterium diphtheriae, imported or endogenous.

Adolescent↗

Prenatal diagnosis of fetal cytomegalovirus infection in seropositive pregnant women.

Thirty two pregnant women, immune to human cytomegalovirus (HCMV) before conception, were examined with a combination of amniocentesis, and blood sampling for fetal HCMV infection. The pregnant women had no history of recurrent infection and they all had normal ultrasonographic findings. Maternal sera and amniotic fluids were examined for anti-HCMV antibodies and viral DNA by enzyme immunoassay and polymerase chain reaction (PCR). All maternal sera were negative for viral DNA and IgM anti-HCMV antibodies. However, HCMV DNA was detected in the amniotic fluid of four pregnant women. These four cases were considered as fetal HCMV infections. Three of them were followed up after birth. The three neonates appeared clinically normal at birth, but HCMV DNA was detected in their urine specimens and in two of them in the cord blood sera. Although the neonates were asymptomatic at birth, the possibility of developing sequelae later on, cannot be excluded. The results show that HCMV recurrent maternal infection is silent and difficult to be suspected and diagnosed. They also show that fetal HCMV infection is not rare among pre-immune pregnant women.

Adult↗

Influenza surveillance in N. Greece during 1983-1993.

Following the WHO programme to monitor influenza, the National Influenza Centre for N. Greece presents the results of a laboratory surveillance during 1983-93. Influenza viruses were isolated every year except for 1986-87 and 1987-88 seasons. Type A viruses predominated in 1983-84, 1985-86, 1988-89 and 1989-90. Type B viruses were prevalent in 1990-91 and 1992-93. Both types of A and B viruses circulated concurrently in the community during the winters of 1984-85 and 1991-92. Seroconversions (CF tests) occurred each year against A, B or both types of influenza viruses. In 1986-87 and 1987-88 when no viruses were recovered, there were seroconversions to B viruses, suggesting influenza B activity in the area. Serological surveys by haemagglutination inhibition (HI) tests were also conducted in 1986-87 and 1988-89. The patterns of the isolated strains were similar to those recorded worldwide at the same time. There have been however differences in the virulence of the viruses and the duration of influenza seasons in this part of the world during 1983-93.

Antibodies, Viral↗

Chlamydia trachomatis in infertile Greek women. A serologic and laparoscopic study.

This study investigates the prevalence of antichlamydial antibodies in infertile women, who underwent diagnostic laparoscopy. The patients were divided into two groups based on the presence or absence of damage of the fallopian tubes. Antichlamydial IgG antibodies were found in 22 of 27 (81.5%) infertile women with damaged fallopian tubes and 10 of 23 (43.5%) women with normal tubes. Mean geometric IgG titres for C. trachomatis were significantly higher in the patients with damaged tubes (187.4 vs. 39.39). C. trachomatis was not isolated from the peritoneal fluids. Only two chlamydial cultures of cervical specimens were positive, one in each group. These findings confirm that C. trachomatis may be a major cause of tubal damage with resultant infertility.

Adult↗

Abnormal overnight dexamethasone suppression test in subjects receiving rifampicin therapy.

We have studied the effects of rifampicin on the overnight 1-mg dexamethasone suppression test usually employed to exclude suspected Cushing's syndrome. Previous observations indicate that in humans, rifampicin profoundly attenuates the biological effects of hydrocortisol and prednisolone, probably by increasing the metabolism of these drugs in the liver. The study was carried out in 16 normal volunteers. All subjects had a normal overnight 1-mg dexamethasone suppression test (468 +/- 86 vs. 32 +/- 21 nmol/L; mean +/- SD). In 8 subjects treated with rifampicin (600 mg) for 10 days, the inhibitory effect of dexamethasone on serum cortisol was completely prevented (575 +/- 114 vs. 434 +/- 82). In the remaining 8 rifampicin-treated subjects, the inhibitory effect of 1, 2, or 3 mg dexamethasone on serum cortisol was not observed. When 4 mg dexamethasone were administered, the serum cortisol level was 193 nmol/L, above the expected normal suppression value. The plasma dexamethasone concentration was very low after rifampicin treatment (range, 1.2-4.8 nmol/L). We conclude that when patients are treated with rifampicin, the standard overnight dexamethasone suppression test not only has no diagnostic value, but can be very misleading.

Adult↗

Rifampicin-induced adrenal crisis in addisonian patients receiving corticosteroid replacement therapy.

Rifampicin induced profound alterations in cortisol metabolism when administered to three patients with primary adrenal failure receiving adequate corticosteroid replacement therapy. In one patient, adrenal crisis was precipitated after the institution of rifampicin therapy for treatment of coexistent tuberculosis and in another, profound asthenia, decrease in blood pressure, hyperkalemia, and hyponatremia developed during the hydrocortisol kinetic study. The clinical symptoms subsided and the electrolyte abnormalities were corrected approximately 7 days after rifampicin withdrawal. The half-life of hydrocortisol and the area under the curve were decreased by 35% and 23%, respectively, whereas the systemic clearance was increased by 35% during rifampicin administration. It appears, that the effectiveness of glucocorticoids and mineralocorticoids were greatly impaired by rifampicin administration due to induction of liver steroid-metabolizing enzymes. It is strongly recommended that in patients with compromised adrenal function, treatment with rifampicin must be accompanied by doubling or tripling the dose of adrenal steroids to maintain adequate steroid replacement therapy.

Acute Disease↗