The economic burden of tuberculosis in Cyprus. A probabilistic cost of illness study.

Background: Tuberculosis remains a major public health problem with considerable economic burden worldwide. The aim of this study was to estimate the economic burden of tuberculosis in Cyprus during 2009.  Methods: A retrospective probabilistic incidence-based cost of illness model was developed to calculate, from the societal perspective, the economic burden of the disease including direct medical costs, direct non-medical costs and indirect costs. The bottom-up approach (person-based data) was used for the calculation of direct costs while for the calculation of indirect costs the approach of human capital was employed. In addition, probabilistic sensitivity analysis with 1000 Monte Carlo simulations was performed in order to calculate a 95% Confidence Interval (CI). Results: Mean per patient cost of tuberculosis in Cyprus in 2009 was estimated at €12,882 (95% CI: €12,747.35 – €12,964.32). Direct medical costs accounted for 83.07% of the overall expenses, €10,675 per patient (95% CI: €10,462.07 – €10,780.59). Total direct non-medical costs of €355 (95% CI: €353.04 – 364.29) accounted for 2.77% of the overall expenses whereas 14.16% of the overall expenses were associated with the indirect cost of €1,820 (95% CI: €1,815.20 – €1,873.65). Conclusion: For the first time in Cyprus, the cost of tuberculosis was estimated using a probabilistic incidence-based cost of illness model.  Our study confirms that tuberculosis is an expensive disease for the society. In addition, it provides important information to policy makers for the comprehension of the economic consequences of tuberculosis so as they can draft the national health policy accordingly and strengthen surveillance of the disease

Expression of YKL-40 and MIP1a proteins in exudates and transudates

Background: YKL-40 is an extracellular matrix glycoprotein with a significant role intissue inflammation and remodeling. MIP-1a has chemotactic and pro-inflammatoryproperties, and is induced by YKL-40 in several lung disorders. The aim of this studywas to determine the levels of YKL-40 and MIP-1a in blood serum and pleural fluids of various pulmonary diseases, and to evaluate their potential role as differentialdiagnosis biomarkers.Methods: We recruited 60 patients (age: 62.5±20.6 years) with pleural effusions: 49exudates and 11 transudates (T). Exudates were further classified based on theunderlying disease: 10 with tuberculosis (TB), 13 with lung cancer (LCa), 15 withmetastatic cancer (MCa) of non-lung origin and 11 with parapneumonic (PN) effusions. YKL-40 and MIP-1a levels were measured by ELISA.Results: Pleural YKL-40 levels (ng/ml) were similar among all patient groups (TB:399±36, LCa: 401±112, MCa: 416±34, PN: 401±50, T: 399±42, p=0.92). On thecontrary, YKL-40 was significantly lower in the serum of TB patients (TB: 58±22, LCa:212±106, MCa: 254±140, PN: 265±140, T: 229±123, p<0.001). Pleural MIP-1a protein levels (ng/ml) were statistically lower only in patients with LCa (TB: 25.0±20.2, LCa:7.3±6.0, MCa: 16.1±14.9, PN: 25.4±27.9, T: 18.5±7.9, p=0.012), a finding also observed in serum MIP-1a levels (TB: 17.1±7.6, LCa: 9.4±7.0, MCa: 28.7±28.7, PN:33.3±24.0, T: 22.9±8.7, p=0.003).Conclusions: Our data suggest that both YKL-40 and MIP-1a, particularly in serum,could prove useful for the differentiation of pleural effusions in clinical practice,especially of TB or LCa origin. However, large-scale studies are needed to validatethese findings.Εισαγωγή:Ο αυξητικός παράγοντας YKL-40 ή Chitinase 3-like 1 protein, εκφράζεται από πολλούς τύπους κυττάρων όπως τα επιθηλιακά, τα λεία μυϊκά κύτταρα, τα πολυμορφοπύρηνα, τα μακροφάγα και τα καρκινικά κύτταρα, έχοντας ρόλο στην ανάπτυξη, στην αναδιαμόρφωση των ιστών και στη φλεγμονή. Στο ίδιο παθογενετικό μονοπάτι η MIP-1a ή Macrophage Inflammatory Protein-1 alpha έχει χημειοτακτική και προφλεγμονώδη δράση ενώ επάγεται από τον YKL-40 σε φλεγμονώδη νοσήματα του πνεύμονα.Σκοπός:Ο ποσοτικός προσδιορισμός της έκφρασης των πρωτεϊνών YKL-40 και MIP-1a στο περιφερικό αίμα και το υπεζωκοτικό υγρό των ασθενών με σκοπό την ανίχνευση βιοδεικτών διαφορικής διαγνωστικής.Μέθοδος:Μελετήθηκαν 60 ασθενείς (ηλικίας: 62.5±20.6 έτη) με υπεζωκοτικές συλλογές: 49 εξιδρώματα και 11 διιδρώματα (T). Τα εξιδρώματα διακρίθηκαν περαιτέρω ανάλογα με την υποκείμενη νόσο σε: 10 με φυματιώδη συλλογή (TB), 13 με συλλογή από πρωτοπαθή καρκίνο του πνεύμονα (LCa), 15 με μεταστατικό καρκίνο από άλλο όργανο (MCa) και 11 με παραπνευμονική συλλογή (PN). Τα επίπεδα των πρωτεϊνών YKL-40 και MIP-1a μετρήθηκαν με την μέθοδο ELISA την 1η ημέρα νοσηλείας.Αποτελέσματα:Τα επίπεδα του YKL-40 στο πλευριτικό υγρό (ng/ml) μετρήθηκαν υψηλά ανάμεσα σε όλες τις ομάδες των ασθενών (TB: 399±36, LCa: 401±112, MCa: 416±34, PN: 401±50, T: 399±42, p=0.92). Αντίθετα τα επίπεδα του YKL-40 ήταν σημαντικά χαμηλότερα στον ορό των ασθενών με φυματιώδη πλευρίτιδα (TB: 58±22, LCa: 212±106, MCa: 254±140, PN: 265±140, T: 229±123, p<0.001). Τα επίπεδα της πρωτείνης MIP-1a στο πλευριτικό υγρό (ng/ml) ήταν στατιστικά χαμηλότερα μόνο στους ασθενείς με πρωτοπαθή καρκίνο του πνεύμονα (TB: 25.0±20.2, LCa: 7.3±6.0, MCa: 16.1±14.9, PN: 25.4±27.9, T: 18.5±7.9, p=0.012), εύρημα το οποίο παρατηρήθηκε και στα επίπεδα της MIP-1a στον ορό (TB: 17.1±7.6, LCa: 9.4±7.0, MCa: 28.7±28.7, PN: 33.3±24.0, T: 22.9±8.7, p=0.003). Συμπεράσματα:Η μέτρηση ταυτόχρονα των επιπέδων των πρωτεϊνών YKL-40 και MIP-1a, ειδικά στον ορό, θα μπορούσε να συμβάλει στην διαφορική διάγνωση των υπεζωκοτικών συλλογών στην κλινική πράξη, ειδικά των φυματιωδών και των κακόηθων πλευριτίδων. Περαιτέρω μελέτες απαιτούνται για την επιβεβαίωση των ευρημάτων αυτών

Clinical features of primary ciliary dyskinesia in Cyprus with emphasis on lobectomized patients

Background: Despite the manifestations of primary ciliary dyskinesia (PCD) in early life, the diagnosis is often much delayed. Since 1998 in Cyprus, we have established the only national diagnostic and clinical referral center for PCD. Objective: To review the phenotypic features at presentation of PCD patients in Cyprus in relation to age at diagnosis, with emphasis on previously lobectomised patients. Methods: The medical records of the diagnosed PCD patients were retrospectively reviewed to obtain clinical data on presentation. Results: Thirty patients, aged 13.9 years (range 0.1, 58.4 years), were diagnosed with PCD. Twelve of them presented after the age of 18. The most common manifestations were chronic cough (100%), chronic rhinorrhea (96.7%), sputum production (92.9%), laterality defects (63.3%), a history of pneumonia (53.3%) and neonatal respiratory distress (50%). A history of lobectomy in the past was recorded in 16.7% (5 patients). Patients who presented in adulthood had significantly higher frequency of lobectomy (41.7% vs 0%, p-value=0.006) and had more frequently low FEV1 (58.3% vs 0%, p-value=0.015) than those who presented before. Serial measurements of FEV1 and FVC indicated significantly lower intercepts in lobectomised compared to the adult non-lobectomised patients both in terms of FEV1 (-4.90 vs -1.80, p-value=0.022) and FVC (-5.43 vs -1.91, p-value=0.029) z-score levels. Change in FEV1 and FVC across time was not statistically significant in either group. Conclusions: PCD often remains undiagnosed up to adulthood accompanied by appearance of advanced lung disease. Performance of lobectomies seems to be a poor prognostic factor for PCD in adulthood

Extensive testing and public health interventions for the control of covid-19 in the republic of cyprus between march and may 2020

Coronavirus disease 2019 (COVID-19) has significantly affected the well-being of individuals worldwide. We herein describe the epidemiology of COVID-19 in the Republic of Cyprus during the first epidemic wave (9 March–3 May 2020). We analyzed surveillance data from laboratory-confirmed cases, including targeted testing and population screening. Statistical analyses included logistic regression. During the surveillance period, 64,136 tests (7322.3 per 100,000) were performed, 873 COVID-19 cases were diagnosed, and 20 deaths were reported (2.3%). Health-care workers (HCWs) represented 21.4% of cases. Overall, 19.1% of cases received hospital care and 3.7% required admission to Intensive Care Units. Male sex (adjusted Odds Ratio (aOR): 3.04; 95% Confidence Interval (CI): 1.97–4.69), increasing age (aOR: 1.56; 95%CI: 1.36–1.79), symptoms at diagnosis (aOR: 6.05; 95%CI: 3.18–11.50), and underlying health conditions (aOR: 2.08; 95%CI: 1.31–3.31) were associated with hospitalization. For recovered cases, the median time from first to last second negative test was 21 days. Overall, 119 primary cases reported 616 close contacts, yielding a pooled secondary attack rate of 12% (95%CI: 9.6–14.8%). Three population-based screening projects, and two projects targeting employees and HCWs, involving 25,496 people, revealed 60 positive individuals (0.2%). Early implementation of interventions with targeted and expanded testing facilitated prompt outbreak control on the island