MD Doctor of Medicine

Affective disorders have consistently been linked to thyroid hormone imbalances. Many symptoms of hypothyroidism overlap with those of major depressive disorder. Because of the tight interaction between the thyroid and adrenal systems, it is not clear whether psychiatric manifestations are attributed to the direct effects of thyroid hormone imbalances, or to resultant changes in adrenal axis function. This study aimed to review and summarize the available evidence on thyroid and adrenal axis involvement in the development of primary affective disorders. The PubMed, Scopus, and ScienceDirect databases were systematically searched and after applying the defined eligibility criteria, twenty-six studies were deemed eligible for this review. The risk of bias was assessed with the use of a modified quality rating system and each study was assigned a specific score. Three types of study designs were included: cross-sectional studies, cohort studies, and case-controlled studies. One of the main findings was an association between depression and subclinical hypothyroidism, specifically an elevation in thyrotropin-releasing hormone (TSH). Evidence of hypothalamic-pituitary-adrenal (HPA) axis hyperactivation, mainly in the form of increased cortisol levels, was also present in depressed patients. Other common findings included a blunted thyrotropin-releasing hormone (TSH) response to thyrotropin-releasing hormone (TRH) stimulation, elevated adrenocorticotropic hormone (ACTH) levels, and dexamethasone suppression test (DST) nonsuppression. The degree of thyroid dysfunction correlated with the severity of psychiatric symptoms, especially in cases of suicidal patients. These findings are in line with clinical recommendations for additional screening for thyroid dysfunction in patients with major depressive disorder and emphasize the need for future research to better comprehend the involvement of the thyroid and adrenal systems in the pathogenesis of depression.

Introduction: Coronary Artery Bypass Grafting (CABG) is part of the standard treatment for ischemic heart disease. It mainly focuses on the revascularization of the ischemic area by creating alternative routes using arterial or venous grafts. Several pre-, peri-, and post-operative factors contribute to the success of a CABG operation. In terms of postoperative management hemodynamic instability and extubation time play a crucial role. Purpose: The purpose of this study was to compare the duration of mechanical ventilation until the time of extubation, the hemodynamic status, and the length of hospital stay in post-CABG patients. Methodology: The study has the form of a retrospective single-centered cohort study. The data collection was done by reviewing the medical files of ninety-two patients undergone isolated on-pump CABG operation from July 2021 until December 2022 in the cardiac surgery department of Apollonion Private Hospital in Nicosia, Cyprus. After completion of data collection, all the reported variables were subcategorized as pre-, peri- and postoperative. Additionally, the patients involved in the study were further subdivided based on their time of extubation into three groups, “very early,” “early” and “regular/late”. Afterward, bivariate and multiple linear regression analyses were performed in order to assess the relationships between extubation time and specific predictor variables. Results: All the included participants were of advanced age (mean=67.58 years). Additionally, a correlation between cardiopulmonary bypass time and cross-clamp time and an association between postoperative volume balance and CRP were, also, revealed. The hemodynamic status seemed to be unaffected by the timing of extubation as atrial fibrillation and duration of vasopressor use did not have any statistical difference. Conclusion: The extubation time does not influence the postoperative status in terms of hemodynamic instability, postoperative complications, and length of hospitalization.

Introduction: The distinction between mesotheliomas and metastatic carcinomas in serous cavities is still a perplexing topic. The present biomarkers of the immunohistochemical panel do not provide solution to this obstacle, since no current biomarker has the adequate specificity and sensitivity to effectively diagnose metastasis in either peritoneal, pericardial, or pleural cavities. Claudin-4, a tight junction transmembrane protein, is a promising biomarker to fill this diagnostic gap due to its selective presence in epithelial and absence in mesothelial cells. Purpose: The purpose of this meta-analysis was to gather all the available data from the present literature and present an overall result for the diagnostic accuracy of claudin-4, as a biomarker of metastasis in serous cavities. Methodology: The meta-analysis was performed based on the PRISMA 2020 statement. The keywords claudin-4, immunohistochemistry, pleural effusion, peritoneal effusion, ascitic effusion, pericardial effusion, and mesothelioma were used to search for relevant articles in PubMed and Scopus. The pre-specified inclusion criteria included original studies reporting Claudin-4 immunohistochemistry or immunocytochemistry in body cavities (pleural, peritoneal, pericardial). A meta-analysis was conducted to estimate the sensitivity, specificity, and diagnostic odds ratio of claudin-4 in pleural, peritoneal, ascitic, and pericardial effusions. Results: Claudin 4 demonstrated high numbers of sensitivity (98.42%) and specificity (99.58%) in diagnosing metastatic carcinomas and differentiating them from malignant mesotheliomas and reactive mesothelial cells. The Diagnostic Odd Ratio (DOR) of this transmembrane biomarker was 1779.9, and the high diagnostic accuracy of claudin 4 as a metastasis detector was further highlighted. No heterogeneity or publication bias of the included studies were observed in this meta-analysis. Conclusion: This was the first systematic presentation of claudin 4 as a biomarker of cytopathological diagnosis. Its diagnostic accuracy in detecting metastasis in serous cavities was clearly depicted. The high numbers of sensitivity and specificity proved the initial research hypothesis and the aim of this metanalysis was achieved.

Introduction: Coronary artery disease is the leading cause of death worldwide. In Cyprus, it constitutes a major disease entity, accounting for numerous deaths. Management is based both on conservative and revascularization options, with the latter being implemented progressively in the past years, notably, CABG being the prime intervention. In Cyprus specifically, the number of patients submitted to revascularization operations is evidently exhibiting one of the forefront frequencies among European countries. Various novel clinical practices aiming to optimize postoperative end-results are currently emerging, one being the introduction of noninvasive ventilation following early extubation of patients that have undergone CABG. Purpose: The primary goal is to demonstrate whether the use of non-invasive ventilation following early extubation on patients having undergone CABG surgery denoted any effect on postoperative complications appearance and severity, and on the length of hospital stay. iii Methodology: A retrospective cohort study including 66 patients from a single center in Nicosia that have had CABG surgery is conducted. They are categorized according to their extubation time; “very early” patients were extubated immediately postoperatively, “early” patients were extubated within 6 hours, and the “regular/late” ones more than 6 hours after completion of the surgery. The sequential use of non-invasive ventilation and any complications that the patients may have encountered, including their length of stay in the hospital, are vital parameters of the study. Results: The demographic profile of the patients had noteworthy differences; gender inequalities were apparent throughout the groups, the age of the patients appeared to be increased and the BMI status of the “regular/late” group was of particular interest. Preoperatively, the three groups of patients displayed uniformity. Intraoperatively, the CPB and CC time noted some differences. Postoperatively, important variations were recorded in terms of WBC count, CRP and volume balances. The use of NIV and the length of hospital stay did not signify any major differences. Conclusions: The patients did not differ in terms of NIV use, and their length of hospitalization appeared to be consistent. Fundamental variations were, however, documented. Further research is necessary to draw definite conclusions.

High-density lipoprotein cholesterol in multiple sclerosis: A systematic review and meta-analysis (Under the supervision of Dr. Aris Dimitrios Angouridis; Steering Committee member A: Dr. D. Papadopoulos; Steering Committee member B: Dr. C. Tsioutis) Introduction: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) and leads to demyelination and axonal degeneration. Evidence showed that lipid metabolism is associated with adverse clinical outcomes in MS. Purpose: To systematically investigate all relevant evidence on the association between high-density lipoprotein cholesterol (HDL-C) and clinical parameters of disease activity in MS. Methodology: The PubMed and Cochrane library databases were searched for studies with data on HDL-C in patients with MS. A qualitative synthesis of published prospective and retrospective studies for the role of HDL-C and other lipid profile parameters in MS was performed. Additionally, a meta-analysis on HDL-C mean differences (MD) between Relapsing Remitting Multiple Sclerosis (RRMS) cases and healthy controls (HC) was performed. Results: Literature search identified 13 potentially eligible trials evaluating the HDL-C of RRMS patients. In total, they included 1652 participants, 819 of which were RRMS patients, and 833 were HC. The pooled analysis demonstrated that RRMS patients had significantly lower HDL-C levels compared with the HC group (MD: -2.99 mg/dl, 95% CI: -5.19, -0.79, p = 0.008). Subgroup analysis did not reveal a significant HDLC concentration difference between RRMS and progressive MS patients (PMS) (MD: 0.34 mg/dl, 95%CI: [-2.66, 3.34], p = 0.82). Regarding triglycerides, pooled analysis from 11 studies (534 RRMS and 589 HC patients) showed significantly higher triglyceride levels in RRMS compared with HC (MD: 22.99 mg/dl, 95% CI: 14.14, 31.83, p < 0.00001). Conclusion: According to our results, low levels of HDL-C represent a potential biomarker of disease activity in MS. Future research opportunities in MS include investigating the role of lipids as potential indicators of disease burden and treatment response biomarkers.