Constantinos Missouris - Academia.edu (original) (raw)

Papers by Constantinos Missouris

Clinical Toxicology, Oct 20, 2019

Figure 4. ECG demonstrating QTc interval normalization (Bazett's and Fridericia's correction 430 ... more Figure 4. ECG demonstrating QTc interval normalization (Bazett's and Fridericia's correction 430 msec and 439 msec, respectively) and stabilization of rhythm over the next 48 hours after alectinib was withheld.

American Journal of Emergency Medicine, Oct 1, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

PubMed, Jan 13, 2022

Purpose: To evaluate the prevalence and incidence of significant structural heart disease in targ... more Purpose: To evaluate the prevalence and incidence of significant structural heart disease in targeted patients with cardiac symptoms referred by general practitioners (GPs) using open access echocardiography, without prior clinical evaluation by a cardiologist. Design: Data were derived from 488 subjects who underwent transthoracic echocardiography between January and April 2018. Patients were referred directly by GPs in East Berkshire, South England, through an online platform. Echocardiography was performed within 4-6 weeks of referral and all reports were assessed by a consultant cardiologist with expedited follow-up facilitated pro re nata. Results were analysed to determine the frequency of detection of structural abnormalities, particularly of the left ventricle and cardiac valves. Results: Echocardiography was prospectively performed in consecutive subjects (50% male, mean (±SD) age 68.5±22 years; 50% female; mean (±SD) 64.6 (±19.1)). At least one abnormality likely to change management was found in 133 (27.3%) of all open access echocardiograms. Clinical heart failure with left ventricular systolic dysfunction (LVSD) and diastolic dysfunction was confirmed in 46 (9%) and 69 (14%), respectively. Of the 46 patients with LVSD, 33 were new diagnoses. Significant cardiac valve disease was found in 42 (8.6%) patients. 12 of these had known valvular disease or previous valvular surgery, and 30 were new diagnoses. Conclusion: Major structural and functional cardiac abnormalities are common in late middle-aged patients who present to GPs with cardiac symptoms and signs. Reported, unrestricted open access echocardiography enables early detection of significant cardiac pathology and timely intervention may improve cardiovascular outcomes.

The American Journal of Medicine, Aug 1, 2020

Research Square (Research Square), Dec 1, 2022

Focal active colitis (FAC) is a non-speci c histological diagnosis of uncertain clinical signi ca... more Focal active colitis (FAC) is a non-speci c histological diagnosis of uncertain clinical signi cance. There is potentially a causal relationship between FAC and in ammatory bowel disease (IBD) in children, but this has not been adequately explored in adults. We sought to evaluate whether FAC is a reliable predictor of developing IBD in adults. Methods patients with FAC were retrospectively identi ed between October 2014 and May 2019 and reviewed using the electronic pathology database at our institution. Patients with known chronic colitis were excluded. Patients were followed up for a mean period of 36 months +/-16. Clinical data and nal diagnoses were recorded, and categorical analysis performed with Fisher's exact χ 2. Results 43 patients (11 male: 32 female, mean age 53 years +/-18) were included. 14 (33%) with FAC were subsequently diagnosed with infective colitis, 5 (12%) with IBD, of which 4 (80%) were diagnosed with ulcerative colitis and 1 (20%) was diagnosed with undetermined IBD. Of 34 patients (79%) with neither raised faecal calprotectin (FC) levels nor suspicious endoscopic ndings, 1 (3%) patient subsequently developed IBD. This was statistically signi cant by Fisher's exact (p = 0.0046), and the phi coe cient of 0.53 demonstrated that patients with neither raised FC levels nor suspicious endoscopic ndings were statistically unlikely to develop IBD. Conclusion Our results suggest that having normal FC levels and endoscopic ndings reduces the risk of future development of IBD in adults. Furthermore, a raised FC level and endoscopic features suggestive of IBD with histological FAC may predict progression to IBD.

Aging medicine, Apr 5, 2023

IntroductionPolypharmacy is a growing phenomenon associated with adverse effects in older adults.... more IntroductionPolypharmacy is a growing phenomenon associated with adverse effects in older adults. We assessed the potential confounding effects of cumulative anticholinergic burden (ACB) in patients who were hospitalized with falls.MethodsA noninterventional, prospective cohort study of unselected, acute admissions aged ≥ 65 years. Data were derived from electronic patient health records. Results were analyzed to determine the frequency of polypharmacy and degree of ACB and their relationship to falls risk. Primary outcomes were polypharmacy, defined as prescription of 5 or more regular oral medications, and ACB score.Key ResultsFour hundred eleven (411) consecutive subjects were included, mean age 83.8 ± 8.0 years: 40.6% men. There were 38.4% patients who were admitted with falls. Incidence of polypharmacy was 80.8%, (88.0% and 76.3% among those admitted with and without fall, respectively). Incidence of ACB score of 0, 1, 2, ≥ 3 was 38.7%, 20.9%, 14.6%, and 25.8%, respectively. On multivariate analysis, age [odds ratio (OR) = 1.030, 95% CI:1.000 ~ 1.050, P = 0.049], ACB score (OR = 1.150, 95% CI:1.020 ~ 1.290, P = 0.025), polypharmacy (OR = 2.140, 95% CI:1.190 ~ 3.870, P = 0.012), but not Charlson Comorbidity Index (OR = 0.920, 95% CI:0.810 ~ 1.040, P = 0.172) were significantly associated with higher falls rate. Of patients admitted with falls, 29.8% had drug‐related orthostatic hypotension, 24.7% had drug‐related bradycardia, 37.3% were prescribed centrally acting drugs, and 12.0% were taking inappropriate hypoglycemic agents.ConclusionPolypharmacy results in cumulative ACB and both are significantly associated with falls risk in older adults. The presence of polypharmacy and each unit rise in ACB score have a stronger effect of increasing falls risk compared to age and comorbidities.

QJM: An International Journal of Medicine, May 3, 2020

Background: Heart failure is a prevalent condition associated with frequent and costly hospital a... more Background: Heart failure is a prevalent condition associated with frequent and costly hospital admissions. Hospitalizations are primarily related to worsening fluid retention and often require admission for decongestion with intravenous diuretics. Objective: To assess the safety of an outpatient intravenous diuresis service for heart failure patients, and its impact on emergency admissions and the cost of treatment. Methods: We conducted a prospective observational cohort registry study on patients referred to the diuretic lounge at our acute hospital between May 2017 and April 2018. Results: We analysed 245 patients treated in the diuretic lounge, of which 190 (77.6%) avoided hospitalization or any adverse events during the 60 days of follow up (77.6% vs. 22.4%; P < 0.001). The diuretic lounge service resulted in a significant decrease in emergency heart failure admissions compared to the previous 12 months (823 vs. 715 per annum; 68.6 6 10.1 vs. 59.6 6 14 per month; P ¼ 0.04), and a numerical reduction in readmission rates (17.3% vs. 16.2%). The 13.1% decrease in admissions lead to financial savings of £315 497 per annum and £2921 per admission avoided. During the same time period, at the other acute hospital site in our trust, where no diuretic lounge service is available, the number of admissions did not significantly change (457 vs. 450 per annum; 37.5 6 7.0 vs. 38.1 6 7.6 per month; P ¼ 0.81). Conclusion: Ambulatory administration of intravenous diuretics reduces emergency admissions and is a safe and cost-effective alternative to treat acute decomposition in heart failure patients.

Cureus, Mar 17, 2023

In 2015, a 37-year-old man was referred for evaluation of hypertension and was found to have a mo... more In 2015, a 37-year-old man was referred for evaluation of hypertension and was found to have a mobile structure on the posterior mitral valve leaflet on echocardiography. Laboratory investigations yielded a diagnosis of primary antiphospholipid antibody syndrome (APLS). He underwent excision of the lesion and mitral valve repair. Histology confirmed the diagnosis of nonbacterial thrombotic endocarditis (NBTE). The patient was anticoagulated with warfarin up until 2018, which was substituted for rivaroxaban because of an erratic international normalised ratio. Serial echocardiography up to 2020 was unremarkable. In 2021, he presented with breathlessness and peripheral oedema. Echocardiography demonstrated large vegetation on both mitral valve leaflets. At the operation, vegetations were also evident on the left and noncoronary cusps of the aortic valve and he underwent mechanical aortic and mitral valve replacement. Histology confirmed NBTE. The case is unusual and highlights recurrent NBTE requiring redo valve surgery.

$Research paper thumbnail of Cause and duration of heart failure may impact on the response to sacubitril/valsartan in patients with heart failure and reduced ejection fraction$

Journal of Cardiovascular Medicine, Sep 9, 2020

To the Editor We read with interest the original article by Villani et al. who observed that trea... more To the Editor We read with interest the original article by Villani et al. who observed that treatment with the angiotensin receptor and neprilysin inhibitor (ARNI) sacubitril/valsartan was associated with favourable left ventricular (LV) remodelling and improvement in pulmonary circulation haemodynamics in patients with a shorter disease duration of heart failure with reduced ejection fraction (HFrEF). In contrast, the clinical benefit in patients with longer disease chronicity was likely related to continued and synergistic vasodilation afforded by the drug combination as demonstrated by the reduction in the degree of mitral regurgitation. This augments the concept that sacubitril/valsartan therapy should be started early in the course of HFrEF.

Clinical Toxicology, Jan 22, 2020

Dear Editor,We thank Professor Atamanalp for the comment on our paper.Our patient suffered recurr... more Dear Editor,We thank Professor Atamanalp for the comment on our paper.Our patient suffered recurrent sigmoid volvulus (SV) which was managed with decompression by sigmoidoscope and insertion of a f...

Diabetes and Metabolic Syndrome: Clinical Research and Reviews, Sep 1, 2021

Annals of medicine and surgery, May 1, 2021

Clinical Medicine, May 1, 2020

Annals of Emergency Medicine, Feb 1, 2021

Case Reports, Apr 1, 2019

Mesalazine (5-aminosalicylic acid)-based products are a widely used treatment for inflammatory bo... more Mesalazine (5-aminosalicylic acid)-based products are a widely used treatment for inflammatory bowel disease in children and adults. Associated myopericarditis is an uncommon but recorded phenomenon related to drug hypersensitivity. Unless recognised, this important complication may culminate in the development of dilated cardiomyopathy and severe heart failure. We report the case of a boy with Crohn’s disease who developed myopericarditis 14 days after starting treatment with mesalazine. Discontinuation of the drug rapidly led to normalisation of left ventricular structure and function, and a parallel improvement in the levels of plasma N-terminal pro-B-type natriuretic peptide and other markers of myocardial damage. Clinicians should be aware of this potentially life-threatening adverse effect of mesalazine therapy, which is quickly and fully reversible on cessation of the agent.

Cardiovascular Drugs and Therapy, Jul 9, 2020

Purpose Sacubitril/valsartan has been demonstrated to improve prognosis and outcomes in heart fai... more Purpose Sacubitril/valsartan has been demonstrated to improve prognosis and outcomes in heart failure with reduced ejection fraction (HFrEF) patients. We sought to compare the improvement in cardiac function between non-ischaemic and ischaemic cardiomyopathy for patients receiving sacubitril/valsartan. Methods We conducted a single centre prospective cohort survey of patients reviewed in the Heart Function Clinic between February 2017 and January 2018. Functional evaluation and measurement of biochemical and echocardiographic parameters occurred before the initiation of sacubitril/valsartan, and after 3 months of treatment. Results We identified 52 patients (26 non-ischaemic and 26 ischaemic cardiomyopathy) suitable for treatment with sacubitril/ valsartan. Treatment was followed by a significant decrease in a New York Heart Association (NYHA) class in both patients with non-ischaemic (2.3 ± 0.6 vs. 1.6 ± 0.7, P < 0.001) and ischaemic cardiomyopathy (2.3 ± 0.5 vs. 1.5 ± 0.6, P < 0.001), along with an increase in ejection fraction in both patients with non-ischaemic (26.2% ± 6.5% vs. 37.2% ± 13.8%, P < 0.001) and ischaemic cardiomyopathy (28.1% ± 5.7% vs. 31.5% ± 8.4%, P = 0.007). The improvement in ejection fraction was significantly greater in the patients with non-ischaemic cardiomyopathy compared to those with ischaemic cardiomyopathy (10.7% ± 13.0% vs. 3.9% ± 6.0%, P = 0.023). Conclusion Our study suggests that treatment with sacubitril/valsartan in patients with non-ischaemic cardiomyopathy is followed by a greater improvement in ejection fraction than in patients with ischaemic cardiomyopathy.

Journal of Medical Virology, Jun 29, 2020

Nephrology Dialysis Transplantation, Apr 1, 1998

Background. Renovascular disease is the most frequently encountered secondary cause of hypertensi... more Background. Renovascular disease is the most frequently encountered secondary cause of hypertension and is one of the few potentially reversible causes of * Currently working in the Department of Cardiology, St Georges Hospital. glucose and cholesterol. Subjects gave informed consent for

British Journal of Clinical Pharmacology, May 3, 2023