Papers by Constantinos Missouris
Clinical Toxicology, Oct 20, 2019
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American Journal of Emergency Medicine, Oct 1, 2020
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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.
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The American Journal of Medicine, Aug 1, 2020
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Research Square (Research Square), Dec 1, 2022
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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.
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QJM: An International Journal of Medicine, May 3, 2020
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The Lancet, Jun 1, 1993
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Cureus, Mar 17, 2023
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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.
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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...
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Diabetes and Metabolic Syndrome: Clinical Research and Reviews, Sep 1, 2021
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Annals of medicine and surgery, May 1, 2021
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Clinical Medicine, May 1, 2020
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Annals of Emergency Medicine, Feb 1, 2021
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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.
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Cardiovascular Drugs and Therapy, Jul 9, 2020
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Journal of Medical Virology, Jun 29, 2020
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Nephrology Dialysis Transplantation, Apr 1, 1998
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British Journal of Clinical Pharmacology, May 3, 2023
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Papers by Constantinos Missouris