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Isolation of Coxiella burnetii by a centrifugation shell-vial assay from ticks collected in Cyprus: detection by nested polymerase chain reaction (PCR) and by PCR-restriction fragment length polymorphism analyses.

Ticks are the principal vectors and reservoirs of Coxiella burnetii. The identification of isolates is necessary for understanding the clinical diversity of Q fever in different geographic areas. This is the first report of isolation of C. burnetii from ticks by the shell-vial assay and by nested polymerase chain reaction (PCR) assay for the detection of this pathogen in ticks. Of 141 ticks collected in Cyprus (Rhipicephalus sanguineus and Hyalloma spp.), 10% were found to be infected with C. burnetii. Three ticks were positive by hemolymph test, and 11 triturated ticks were positive by nested PCR. Three isolates were obtained by the centrifugation shell-vial technique. Analysis by PCR, then restriction fragment length polymorphism showed that the 3 Cyprus isolates had identical restriction profiles to reference strains Nine Mile and Q212. The methods described are useful in studying the epidemiology and ecology of C. burnetii.

Animals↗

Molecular screening of fragile X (FRAXA) and FRAXE mental retardation syndromes in the Hellenic population of Greece and Cyprus: incidence, genetic variation, and stability.

This study presents the first large, population-based molecular investigation of the fragile X (FRAXA) and FRAXE mental retardation syndromes in the Hellenic populations of Greece and Cyprus. The aims of this population screening were to determine the prevalence of FRAXA and FRAXE syndromes among idiopathic mentally retarded (IMR) individuals, to estimate the incidence in the general population, and to investigate the molecular mechanism of instability and expansion of the FMR1-repeat. Ten FRAXA patients were identified to have either the full mutation (eight) or premutation (two) from a Hellenic population of 866 unrelated IMR individuals (611 males and 255 females, age range 3-25 years). No FRAXE patients were identified among the 611 IMR males. The incidence of FRAXA in the Hellenic population of Cyprus is estimated at 1 in 4,246 males. The repeat sites from the FMR1 and FMR2 alleles were accurately determined and showed similar distribution and frequencies with other population studies. The analysis of AGG interspersion within the FMR1-repeat in normal males revealed long, pure CGG repeats within the "gray zone" as well as variation within the 3' end showing polarity of instability. This finding supports the hypothesis that the AGG interspersion and the length of the pure repeat are major factors in determining allele stability. Analysis of FRAXAC1, DXS548, and FRAXAC2 identified particular alleles and haplotypes to have a significant association with either gray zone alleles or alleles >15 pure CGG repeats. We hypothesize that this subgroup of alleles and haplotypes are associated with long pure CGGs (>15 CGG) or 35 repeats and, having shared an evolutionary past, would have the tendency to expand.

Adolescent↗

The Cyprus experience with protection of ground- and surface waters from domestic sewage and excreta.

Water resources in Cyprus are scarce and expensive to exploit; rainfall is highly variable and droughts occur frequently. The Cyprus authorities are concerned with the conservation and protection of water supply sources. For this purpose the Water Pollution Control Law has been issued. According to the Street and Buildings Law, all dwellings must be equipped with a septic tank, followed by an absorption pit. When the pits overflow due to saturation of the soil, the septage is pumped out and transported to a sewage treatment plant for treatment and reuse. Based on land-use zoning, housing developments are not allowed in the vicinity of water-supply sources, rivers and reservoirs. In order to avoid contamination of the water sources from sewage and excreta, protection zones are designated in which the disposal of sewage is not allowed.

Conservation of Natural Resources↗

Prevalence and age of identification of permanent childhood hearing impairment in Cyprus.

Permanent childhood hearing impairment is a significant public health issue in the United Kingdom and elsewhere. It has effects on the hearing-impaired individual's linguistic, psychological, educational, and vocational development. Data on prevalence are an essential prerequisite for efficient service planning and development. This paper reports the first study to be undertaken in Cyprus to investigate the prevalence and the age at identification of permanent bilateral (congenital or acquired/late-onset) childhood hearing impairment of 50 dB HL or greater. The study was based upon a case ascertainment approach for children born between 1979 and 1996. Two methods were employed for the data collection: interrogation of case records and questionnaires administered to parents. The results for those years in which most cases are likely to have been identified showed an estimated prevalence of 1.19/1,000 live births (congenital) and 0.40/1,000 live births (acquired/late onset), with a mean identification age of 44.0 months for congenital cases. These findings are discussed with reference to the service development needs in Cyprus.

Adolescent↗

THE LONG-TERM TREND IN PREVALENCE OF TUBERCULOSIS INFECTION IN CYPRUS.

Two tuberculin testing surveys have been carried out in schools in Cyprus by WHO teams, one in 1955 and one in 1963. It happens that three schools in Nicosia were included in both surveys, thus permitting a direct study of the time-trend in prevalence of tuberculosis infection; there are good reasons to believe that the techniques of the two surveys were sufficiently comparable for this purpose. In the 1955 survey, 42 children were found to be infected out of the 1532 who were tested and had their reactions read, while, in the 1963 survey, 24 children were found to be infected among 1680. The difference between the two rates is statistically significant at the 1% level, and it is concluded that tuberculosis infection is on the decline in Cyprus.

Adolescent↗

Selected eHealth applications in Cyprus from the training perspective.

OBJECTIVES: In this paper a review of selected eHealth applications in Cyprus is presented linked with their success or failure based on their training activities. METHODS: The eHealth systems presented and their training activities include an update of the health information system (HIS) in the public hospitals, a medical system for emergency telemedicine (AMBULANCE and EMERGENCY-112 projects), a home monitoring system for cancer patients (DITIS), a satellite-based network in healthcare applications (EMISPHER and HEALTHWARE projects), and the training activities of the Cyprus Society of Medical Informatics. Different methodologies for training were used ranging from classical approaches like train the trainers, using demo cases followed by personal training, group training, and workshops, to more recent methodologies based on eLearning sessions including teleconsultations. RESULTS: The training was carried out successfully in all cases. However, not all eHealth systems were put into practice successfully, mainly for reasons not related to training. CONCLUSIONS: It is anticipated that this paper will promote the importance of these applications and their training activities as well as help in the spin off of others thus enabling the offering of a better service to the citizen.

Computer Communication Networks↗

Enterotoxin antibodies in relation to diarrhoea in Swedish soldiers in Cyprus.

The development of antibodies to Escherichia coli heat-labile enterotoxin (LT) and its relationship to diarrhoea was studied in two Swedish battalions (one in the winter, WB, and one in the summer, SB) of the United Nations Peace-keeping Force in Cyprus. Whereas only 6-15% of the soldiers had detectable levels of anti-LT antibodies in their sera before leaving Sweden, as many as 69% of the SB and 43% of the WB soldiers who developed diarrhoea in Cyprus acquired significant titres of enterotoxin antibodies in their sera (acute phase serum). During the summer, many soldiers without diarrhoea also obtained anti-LT antibodies, whereas no such response was observed in healthy soldiers during the winter. Civilian Turkish Cypriots had positive sera in high frequency (60-66%) during both study periods. Parallel titration of positive sera against E. coli LT and cholera toxin indicated that the enterotoxin-neutralizing antibodies registered were induced by bacteria producing enterotoxin identical or closely related to LT.

Antibodies, Bacterial↗

Organophosphate resistance in Culex pipiens from Cyprus.

Populations of Culex pipiens were sampled from 8 locations in Cyprus between 1987 and 1993. All population samples generally revealed organophosphate resistance to malathion, temephos, chlorpyrifos, fenthion, dichlorvos, and pirimiphos methyl, in decreasing order of magnitude. Of 7 populations assessed with the carbamate propoxur, all proved to be resistant to different degrees. Of the 6 populations tested with permethrin, 2 were resistant to permethrin. Resistance was associated with the presence of 5 different overproduced esterases (esterases A1, A2, A5, B2, and B5) as well as an insensitive form of acetylcholinesterase. These results are discussed in relation to the ongoing mosquito abatement program in Cyprus and to similar programs in other parts of the world.

Animals↗

Actualistic Ophiolite Provenance: The Cyprus Case.

The island of Cyprus represents an excellent site to assess quantitatively petrologic clastic response to actively obducting oceanic sources in order to define an actualistic reference for ophiolite provenance, in terms of framework composition and heavy mineral suites. An improved methodology, an extension of the classic ternary QFL logic to include a wider spectrum of key indexes and ratios, provides an accurate synthesis of modal data and allows differentiation of three main petrographic provinces and at least seven subprovinces. Diagnostic signatures of detritus from various levels of an oceanic lithospheric source, and criteria for distinguishing provenance from suprasubduction versus mid-oceanic ophiolites are also outlined. Modern sands derived from the Troodos Ophiolite contain variable proportions of largely pelagic carbonate to chert, boninite to basalt, diabase to metabasite, plagiogranite to gabbroic, and cumulate grains supplied from progressively deeper-seated levels of the multilayered oceanic crust. Dense minerals are mainly clinopyroxenes (diopside), prevailing over orthopyroxenes (enstatite, hypersthene, clinoenstatite), hornblende, tremolite/actinolite, and epidote. Where serpentinized mantle harzburgites have been unroofed, detritus is markedly enriched in cellular serpentinite grains and enstatite, with still negligible olivine and spinel. Sedimentaclastic sands dominated by chert (Mamonia Province) or carbonate grains (Kyrenia Province) are deposited along the southern and northern shores of the island, respectively. Compositions of Cyprus sands are virtually unaffected by climatic, sedimentary, or anthropic processes; recycling of sandstones from foreign sources is a major process only in the Karpaz Peninsula. Petrographic analysis also provides an independent mean to identify prevalent directions of longshore sand transport.

Journal Article↗

Indoor and outdoor in situ high-resolution gamma radiation measurements in urban areas of Cyprus.

In situ, high-resolution, gamma-ray spectrometry of a total number of 70 outdoor and 20 indoor representative measurements were performed in preselected, common locations of the main urban areas of Cyprus. Specific activities and gamma absorbed dose rates in air due to the naturally occurring radionuclides of (232)Th and (238)U series, and (40)K are determined and discussed. Effective dose rate to the Cyprus population due to terrestrial gamma radiation is derived directly from this work. The results obtained outdoors match very well with those derived previously by high-resolution gamma spectrometry of soil samples, which were collected from the main island bedrock surface. This implies that the construction and building materials in urban areas do not affect the external gamma dose rate; thus they are mostly of local origin. Finally, the indoor/outdoor gamma dose ratio was found to be 1.4 +/- 0.5.

Air Pollutants, Radioactive↗

Evidence for high-risk haplotypes and (CGG)n expansion in fragile X syndrome in the Hellenic population of Greece and Cyprus.

The expansion of the trinucleotide repeat (CGG)n in successive generations through maternal meiosis is the cause of fragile X syndrome. Analysis of CA repeat polymorphisms flanking the FMR-1 gene provides evidence of a limited number of "founder" chromosomes and predisposing high-risk haplotypes related to the mutation. To investigate the origin of mutations in the fragile X syndrome in the Hellenic populations of Greece and Cyprus, we studied the alleles and haplotypes at DXS548 and FRAXAC2 loci of 16 independent fragile X and 70 normal control chromosomes. In addition, we studied 191 unrelated normal X chromosomes for the distribution and frequencies of CGG alleles. At DXS548, 6 alleles were found, 2 (194 and 196) of which were represented on fragile X chromosomes. At FRAXAC2, 6 alleles were found, 4 of which were present on fragile X chromosomes. Sixteen haplotypes were identified, but only 5 were present on fragile X chromosomes. The highest number of CGG repeats (> or = 33) were associated with haplotypes 194-147, 194-151, 194-153, and 204-155. The data provide evidence for founder chromosomes and high-risk haplotypes in the Hellenic population.

Cyprus↗

A report on missile injuries in Cyprus 1974.

This paper details the experiences of the Princess Mary's Royal Air Force Hospital, Akrotiri (TPMH), during the last 6 months of 1974. TPMH was at that time a small hospital (120 beds) with a clinical staff of 17 situated in the south of Cyprus (fig. 1). The series comprises 71 patients injured by bullets, shrapnel, bomb-blasts or mines, drawn from British personnel, United Nations Forces and the local Cypriot military and civilian population, resulting from the coup d'état of 15 July 1974 and the subsequent Turkish invasion and air attacks. The casualties were often severely wounded beyound the capabilities of the local hospitals. They were mostly admitted during a 2-week period, but many required multiple operations extending over the next 3 or 4 months, and altogether 119 operations were carried out on 41 patients at TPMH. The organization of the limited resources of the medical, nursing and supporting staff is outlined. The correct treatment of missile wounds is emphasized. Resuscitation, wound excision, splintage and delayed suture or grafting are essential. Minimal morbidity and mortality are gained by a practised approach to the compounded results of violence.

Adult↗

Underexpression of the apolipoprotein E2 and E4 alleles in the Greek Cypriot population of Cyprus.

Apolipoprotein E (APOE) plays an important role in the multifactorial etiology of both cardiovascular disease and Alzheimer's disease. Polymerase chain reaction (PCR) was used to investigate the APOE gene polymorphism in 335 unrelated Greek Cypriots living on the island of Cyprus. For the most common APOE genotypes, the Greek Cypriots followed the general Caucasian European pattern of having higher genotypic frequencies of E3/3, followed by E3/4, and then E2/3. Among the European populations compared, Greek Cypriots exhibited the lowest relative frequency of the E3/4 genotype (12.83%). Also, the relative frequencies of the E2 and E4 alleles in Greek Cypriots were among the lowest around the world (5.4% and 7.0%, respectively). This was also demonstrated by using the complete and the average clustering methods of analysis where the APOE allele relative frequencies in Greek Cypriots were compared to 46 other populations. The Greek Cypriot population in these analyses clustered with populations mainly from south Europe and Japan which have low E2 and E4 allele frequencies. The Greek Cypriot population will be studied further for elucidating the effect(s) and the role of APOE in cardiovascular disease and the APOE4 allele as a possible metabolic factor affecting the rate of expression of both Alzheimer's disease and vascular dementia.

Adolescent↗

The impact of quality on the demand for outpatient services in Cyprus.

Health policy reforms in a number of countries seek to improve provider quality by sharpening the incentives they face, for example by exposing them to greater competition. For this to succeed, patients must be responsive to quality in their choice of provider. This paper uses data from Cyprus to estimate the effect of quality on patients' choice between public and private outpatient care. It improves on the existing literature by using a more comprehensive set of quality attributes which allows the dimensions of quality that have the largest effect on patient choice of provider to be identified. We also introduce an innovative way of measuring patients' perceptions of quality in a household survey. We find that patients' choice of provider is sensitive to quality, and that interpersonal quality is more important than either technical quality or system-related factors.

Ambulatory Care↗

Mutation analysis of a Sandhoff disease patient in the Maronite community in Cyprus.

Sandhoff disease occurs in the Christian Maronite community in Cyprus, a community that established over a thousand years ago. Nowadays, this community comprises less than 1% of the whole population, and has been culturally and socially isolated. Cultured fibroblasts from a patient from this inbred group showed a beta-hexosaminidase beta subunit mRNA of apparently the normal size but of reduced quantity. A mutational analysis of cDNA obtained by polymerase chain reaction amplification of mRNA showed a deletion of A at nt 76 (counted from A of the initiation codon, ATG). The deletion results in a frame shift and a premature termination within 20 amino acids from the N-terminus of the normal mature enzyme protein. The patient was homozygous for the deletion. The 5'-end of the gene showed many discrepancies from the previously published sequence. We consider that these differences are probably polymorphisms of little functional significance, because the patient's fibroblasts generate decreased but stable mRNA and because some of these base changes were also found in the genes from control fibroblasts. An extensive evaluation of the prevalence of this mutant allele in this community is being initiated.

Base Sequence↗

The 1977 outbreak of bluetongue in Cyprus.

Bluetongue outbreaks, ranging from isolated cases to widespread infections, have occurred in Cyprus in about half of the years since 1924. Serious outbreaks occurred in 1924, 1939, 1943, 1946, 1951, and 1965. Most cases occurred in September, October, November and December. The last outbreak prior to 1977 was in 1969. Virus types isolated in the past were types 3 and 4. In 1977 the outbreak was serious, affecting 13.1 per cent of 27,837 in-contact sheep; these were scattered in 303 flocks of 65 villages throughout the Government-controlled area. The virus type isolated was type 4. Culicoides were involved in bluetongue transmission in the island.

Animals↗

Newcastle disease in Cyprus: a review.

The first Newcastle disease epidemic in Cyprus was reported in 1949 to 1950 and between 1953 and 1959 there was a second. In November 1977 another Newcastle disease outbreak occurred. Measures implemented immediately were; quarantine of all foci of infection, destruction of diseased and in-contact birds disinfection of premises and island-wide (Government controlled) vaccination. Within a month the epidemic was brought under control. In all 47 outbreaks were recorded with the loss of about 35,000 birds. Only 2 commercial units were affected, the remaining outbreaks occurring in premises of back-yard poultry keepers. The virus was the Asiatic type.

Animals↗