University Hospital of Alexandroupolis

Abstract Objective We assessed impact of PCSK9 inhibitors (PCSK9i) on carotid intima-media thickness (cIMT) and their interplay with lipid profile parameters. Methods Systematic review conducted in accordance with PRISMA guidelines. Primary endpoint was cIMT reduction (millimetres). Meta-regression examined influence of demographic, imaging, and biochemical parameters on cIMT. Heterogeneity exploration was conducted via leave-one-out and Baujat plot analyses. Results Four randomized controlled trials comparing PCSK9i plus statin versus placebo plus statin, and two single-arm studies were included, enrolling 607 patients and 2175 carotid segments. Pooled analysis demonstrated significant reduction in cIMT; mean difference (MD) −0.03 (95%c.i.: −0.05 to −0.01) (I2 = 95.4%, P < 0.01). Following exploration and mitigation of heterogeneity, this reduction persisted; MD −0.01 (95%c.i.: −0.02 to −0.01) (I2 = 0%, P = 0.59). Initially, comparison between PCSK9i and placebo yielded non-significant cIMT reduction favouring PCSK9i; MD −0.04 (95%c.i.: −0.10 to 0.03) (I² = 98.6%, P < 0.01). Following heterogeneity adjustment, effect estimate reached statistical significance, demonstrating consistent cIMT reduction with PCSK9i; MD −0.01 (95%c.i.: −0.02 to −0.01) (I² = 52%, P = 0.12). Meta-regression displayed associations between baseline cIMT (β = −0.45, P < 0.01), HDL (β = 1.92, P < 0.01) and cIMT. Pooled between-group cIMT differences showed moderate correlations with the respective differences in total (r = 0.69) and LDL cholesterol (r = 0.59). Conclusions Evidence supports potential association between PCSK9i treatment and cIMT reduction, with observed correlations involving total and LDL cholesterol indicating lipid-mediated vascular response. These findings warrant cautious interpretation given substantial heterogeneity, partly driven by baseline differences in cIMT and lipid profiles. Future studies should ensure baseline comparability in vascular and biochemical parameters to strengthen causal inferences.

Objective: Nocturia, defined as waking from sleep to void, is a frequent lower urinary tract symptom associated with impaired sleep quality and reduced quality of life. This study aimed to evaluate the prevalence of nocturia episodes and their impact on sleep disturbance and health-related quality of life. Methods: A questionnaire-based cross-sectional study was conducted at the Urology Outpatient Clinic of the General Hospital of Eastern Achaia between November 2023 and May 2024. Participants reporting nocturia were assessed using the Nocturia Quality of Life (N-QOL) questionnaire, the Athens Insomnia Scale (AIS), and the EQ-5D questionnaire. Demographic data and comorbid conditions were also collected. Univariate analyses and multiple linear regression were applied to identify factors associated with nocturia-related outcomes. Results: A total of 89 participants (78 men and 11 women; mean age 68.9 years) were included. Most participants reported 2-3 nocturnal voids per night. The N-QOL score was significantly associated with the frequency of nocturia episodes (r = -0.55, p < 0.0001), and regression analysis confirmed this relationship (coefficient: -6.7; 95% CI: -10.4 to -3.1). Individuals scoring ≥ 8 on the OAB-V8 scale demonstrated significantly lower N-QOL performance. Conclusions: Increasing nocturia frequency is associated with impaired sleep, reduced vitality, and diminished quality of life, particularly among older adults. Nocturia should be recognized as a clinically relevant symptom requiring targeted evaluation and personalized management strategies.

Background/Objectives: Chronic lower-limb ulcers of mixed etiology are characterized by impaired microcirculation and persistent inflammation, leading to delayed healing, frequent hospitalizations, and a high risk of limb loss. While infrared thermography reflects local perfusion status and systemic inflammatory markers capture whole-body immune activation, these dimensions are usually assessed separately. The objective of this study was to develop and internally evaluate a composite Thermal-Inflammatory Index (TI) integrating wound-bed thermography with systemic inflammatory markers to stratify disease severity and prognosis in patients with chronic lower-limb ulcers. Methods: In this prospective observational study, 82 adults with chronic lower-limb ulcers underwent baseline infrared thermographic assessment of wound-bed temperature using a standardized protocol. Concurrently, neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) were measured. The Thermal-Inflammatory Index was constructed as a standardized composite of inverted wound-bed temperature, NLR, and CRP. A simplified TI score (0-3) was derived using predefined clinical thresholds. The primary endpoint was a composite adverse outcome defined as amputation or failure to achieve complete wound healing within 12 weeks. Secondary outcomes included a prolonged hospital stay (>7 days). Discriminative performance was assessed using receiver operating characteristic analysis, and associations were examined using correlation and logistic regression models. Results: Higher TI values were associated with colder wound beds, elevated systemic inflammatory markers, and increased disease burden. The TI demonstrated moderate discrimination for the composite adverse outcome (AUC 0.75) and prolonged hospitalization (AUC 0.71), performing comparably to the strongest single component (-T_bed, AUC 0.77) while integrating local and systemic information. Each one-standard-deviation increase in TI was independently associated with higher odds of the composite adverse outcome and a prolonged hospital stay. The simplified TI score showed clear stepwise gradients in adverse outcomes and length of hospitalization. Conclusions: The Thermal-Inflammatory Index integrates thermographic and inflammatory signals into a single, clinically interpretable biomarker of severity and prognosis in chronic lower-limb ulcers. TI and the simplified TI score may support early risk stratification using low-cost, bedside-accessible data.

Abstract Background Identifying pathogenic/likely pathogenic variants in high-risk cancer genes is key to cancer risk management.Prophylactic surgeries like RRM and RRSO are guideline-recommended options. This study aims to provide real-world evidence on their clinical implementation. Methods Between 2020 and 2025, 203 women referred for genetic testing at Genekor Medical S.A., were detected with P/LP variants in cancer susceptibility genes, for which risk-reducing surgical options are either recommended or considered for discussion. Referring clinicians were invited to complete a questionnaire to assess whether prophylactic surgical options had been discussed, if the patients had agreed to undergo such procedures, and whether the surgeries have already been performed or postponed. Results Among the individuals referred for genetic testing, 168(83%) were referred following a cancer diagnosis, while 35(17%) were unaffected individuals referred due to a family history. 153 individuals (76%) harbored BRCA1/2, 31(15%) harbored PALB2, PTEN, TP53 and 19 (9%) harbored BRIP1,RAD51C, RAD51D P/LP variants. RRSO was discussed with 78/153 (51%) of BRCA1/2 carriers and agreed in 60/78 (77%) cases. Addition of hysterectomy to RRSO was discussed in 16/78 (21%) of cases and agreed in 10/16 (63%). RRM was discussed with 113/203 (56%) of patients and agreed in 73/113(65%). In PALB2, PTEN, TP53 carriers, RRM was discussed in 21/31 (68%) cases, and accepted in 9/21 (43%), while in 5 cases both RRM/RRSO were discussed with 3 women agreeing. Finally, for 19 BRIP1,RAD51C, RAD51D carriers, in 9 cases the physician discussed RRSO as an option, with the examinees agreeing in 7 of them and in 5 cases RRM was discussed with agreement to proceed in 2 of them. In all cases, 22 individuals although agreed to proceed with RRM and/or RRSO, decided to postpone the procedure. Conclusions This study highlights the high awareness and acceptance of surgical management demonstrating the adherence to the recommendations. Age under 35 years and receiving therapy at the time of genetic testing were significant factors in lowering risk reduction RRSO and hysterectomy performance rates. Stage IV cancer was the main reason for not discussing surgical intervention. Citation Format: K. Papazisis, M. Paraskeva, S. Giassas, M. Skondra, R. Iosifidou, C. Tolis, G. Kesisis, E. Zairi, V. Venizelos, C. Markopoulos, I. Natsiopoulos, E. Bleka, I. Xanthakis, A. Ananiadis, D. Matheos, D. Stefanou, A. Adamidis, A. Meintani, G. Kapetsis, D. Bouzarelou, E. Papadopoulou, G. Nasioulas. High-risk cancer susceptibility genes mutation carriers’ compliance with surgical risk reduction for breast and ovarian cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-05-05.

Periprosthetic Joint Infection (PJI) remains one of the most challenging complications in arthroplasty, often leading to diagnostic uncertainty and suboptimal treatment decisions. Synovial calprotectin has emerged as a promising biomarker, with the lateral flow test (LFT) offering real-time results for intraoperative decision-making. This meta-analysis aimed to evaluate the diagnostic accuracy of intraoperative synovial calprotectin LFT in detecting PJI. A systematic review and meta-analysis were conducted according to PRISMA guidelines. Thirteen studies comprising 990 patients were included. Pooled sensitivity, specificity, positive and negative predictive values (PPV, NPV), likelihood ratios (LR+, LR−), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated using a random-effects model. Subgroup analyses were performed based on test kit type and calprotectin cutoff values. The pooled sensitivity and specificity of synovial calprotectin LFT were 88% (95% CI: 82–92%) and 89% (95% CI: 83–93%), respectively, with an AUC of 0.94. The DOR was 56.1 (95% CI: 28.4-110.8). The ≥ 50 mg/L cutoff subgroup demonstrated superior diagnostic performance across all metrics. Despite subgroup analysis, heterogeneity remained high (I² = 74.1%), likely due to differences in reference standards, joint types, and study design. Intraoperative synovial calprotectin LFT is a highly accurate and rapid diagnostic tool for PJI, with strong applicability in real-world surgical settings. Its cost-effectiveness and ease of use support its integration as a valuable adjunctive marker within standard diagnostic algorithms, providing supplementary evidence when conventional criteria remain inconclusive.

Objective: The objective of this study was to evaluate the association between cervical management strategies, specifically pessary placement, cervical cerclage, or expectant management, and gestational age at delivery in twin pregnancies and to assess the prognostic value of cervical characteristics for early preterm birth (<33 weeks). Methods: We conducted a retrospective cohort study including 120 twin pregnancies managed at a tertiary referral center between 2019 and 2024. Pregnancies with positive vaginal or cervical microbiological cultures or abnormal cervical cytology were excluded. The management strategy was selected based on cervical characteristics and clinical judgment. Gestational age at delivery was compared across intervention groups using descriptive statistics, kernel density plots, boxplots, and Kaplan-Meier survival analysis. Multivariable Cox proportional hazards regression was performed to estimate adjusted hazard ratios (HRs) for early delivery, including intervention type and cervical parameters (length, diameter, and funneling). Results: Overall, 26 of 120 pregnancies (21.6%) resulted in delivery before 33 weeks. Pessary placement was associated with longer gestational duration compared with cerclage or expectant management. Kaplan-Meier analysis demonstrated a clear separation of survival curves by intervention group, with the pessary group maintaining pregnancy to later gestational ages (log-rank p < 0.001). In multivariable Cox regression analysis, pessary use was associated with a significantly lower hazard of early delivery compared with cerclage (HR = 0.088, 95% CI: 0.035-0.220; p < 0.001). Expectant management showed a trend toward an increased risk of early delivery (HR = 2.44; p = 0.067). Cervical length and diameter were not independently associated with early delivery after adjustment for intervention type. Funneling was associated with a lower hazard of early delivery, a finding that warrants cautious interpretation. Conclusions: In this retrospective cohort of twin pregnancies without microbiological evidence of infection, pessary placement was associated with prolonged gestation and a lower hazard of early preterm delivery compared with cerclage or expectant management. These findings support a personalized, risk-adapted approach to cervical intervention selection in twin pregnancies. Prospective, randomized studies incorporating etiologic stratification are needed to confirm these associations and guide clinical practice.

<h2>Abstract</h2><h3>Objective</h3> We assessed the impact of proprotein convertase subtilisin-kexin type 9 inhibitor (PCSK9i) on carotid intima-media thickness (cIMT) and their interplay with lipid profile parameters. <h3>Methods</h3> A systematic review was conducted in accordance with the PRISMA 2020 guidelines. The primary end point was cIMT reduction in millimeters by the end of treatment. A metaregression analysis was performed, examining the influence of demographic, imaging, and biochemical parameters on cIMT outcomes. Heterogeneity exploration was conducted via leave-one-out and Baujat plot analysis. <h3>Results</h3> Four randomized controlled trials comparing PCSK9i plus statin vs placebo plus statin, and two single-arm studies were included, enrolling 607 patients and 2175 carotid segments. Pooled analysis demonstrated a significant reduction in cIMT from baseline to completion of PCSK9i therapy (mean difference [MD], −0.03; 95% confidence interval [CI], −0.05 to −0.01; I² = 95.4%; <i>P</i> < .01). After exploration and mitigation of heterogeneity, this decrease persisted (MD, −0.01; 95% CI, −0.02 to −0.01; I² = 0%; <i>P</i> = .59). Initially, the comparison between PCSK9i and placebo yielded a nonsignificant reduction in cIMT by the end of follow-up, favoring PCSK9i (MD, −0.04; 95% CI, −0.10 to 0.03; I² = 98.6%; <i>P</i> < .01). However, after heterogeneity adjustment, the effect estimate reached statistical significance, demonstrating a consistent cIMT reduction with PCSK9i (MD, −0.01; 95% CI, −0.02 to −0.01; I² = 52%; <i>P</i> = .12). Metaregression analysis displayed associations between baseline cIMT (β = −0.45; <i>P</i> < .01), high-density lipoprotein cholesterol (β = 1.92; <i>P</i> < .01), and cIMT outcomes. Pooled between-group cIMT differences showed moderate correlations with the respective differences in total (r = 0.69) and low-density lipoprotein cholesterol (r = 0.59) across the included studies. <h3>Conclusions</h3> This review provides evidence supporting a potential association between PCSK9i treatment and cIMT reduction, with observed correlations involving total and low-density lipoprotein cholesterol indicating a lipid-mediated vascular response. Nonetheless, these findings warrant cautious interpretation given the substantial heterogeneity, partly driven by baseline differences in cIMT and lipid profiles. Future studies should ensure baseline comparability in vascular and biochemical parameters to strengthen causal inferences.

Background: Visceral Leishmaniasis (VL), a severe systemic parasitic disease caused by Leishmania species, can be complicated by secondary Hemophagocytic Lymphohistiocytosis (HLH). HLH is a life-threatening hyperinflammatory syndrome characterized by excessive immune activation that results in multiorgan dysfunction. The co-occurrence of VL and HLH in adults is a rare but critical diagnostic and therapeutic challenge, often leading to fatal outcomes if treatment is delayed. Case Presentation: We present two cases of adult males (60 and 72 years old) from Greece, an endemic area for L. infantum, who presented with prolonged fever, pancytopenia, hepatosplenomegaly, and impaired liver function. Both patients exhibited extremely elevated ferritin (all > 2000 ng/mL and one > 20,000 ng/mL) and hypertriglyceridemia, fulfilling key laboratory criteria for HLH. Diagnosis was confirmed by the visualization of Leishmania amastigotes in bone marrow aspirates, which also demonstrated features of hemophagocytosis. Case 1, critically ill with acute kidney injury and coagulopathy, required combined treatment with liposomal Amphotericin B and immunoglobulin therapy for HLH. Case 2, who showed rapid and "spectacular improvement" solely after receiving liposomal Amphotericin B, did not require HLH-specific immunosuppression. Conclusions: VL-associated HLH should be considered in adult patients presenting with complex systemic inflammation, fever, and cytopenias, particularly in endemic settings. Our cases illustrate that the prompt initiation of anti-leishmanial therapy with liposomal Amphotericin B can be sufficient to reverse the HLH syndrome by eliminating the infectious trigger. However, intensive immunomodulation may be necessary in patients presenting with critical multi-organ failure.