Δημοσιεύσεις

Konstantinos Makris Andrianou XD, Pcharisiadis and KC Makris   Journal Proteome Research 2017 (http://pubs.acs.org/doi/full/10.1021/acs.jproteome.6b01061 Coupling Urinary Trihalomethanes and Metabolomic Profiles of Type II Diabetes: A Case-Control Study
Konstantinos Makris Gaengler S., Andrianou X.D., Piciu A., Charisiadis P., Zira C., Aristidou K., Piciu D., Makris K.C. A study on possible risk factors of thyroid nodules. Romania served as a reference with a comparative thyroid cancer prevalence < EU average. This study aimed to assess the association between urinary iodine (UI) and thyroid nodules in adult females (n = 208) from Cyprus and Romania. A case-control study. Cases were females with ultrasound-confirmed thyroid nodules and controls with confirmed absence of nodules. Subjects underwent ultrasound medical examinations, completed a questionnaire and offered a spot urine sample. Median UI level in Cyprus was 94 μg/L, whereas 32% of the Cypriot UI was < 50 μg/L, classifying the population as mildly iodine deficient. In Romania, both cases and controls were iodine sufficient. No significant differences (P > 0.05) in serum free thyroxin (fT4) and thyroid stimulating hormone (TSH) levels were found between cases and controls. Cases had lower median TSH levels compared with controls (1.4 mIU/L and 1.7 mIU/L, P = 0.060), but serum TSH and free thyroxin levels were within normal range. This was the first study to quantify UI levels in Cyprus. While the Romanian iodine fortification programme reflected onto its UI levels, a representative assessment of iodine status in Cyprus will address the necessity of an iodine fortification programme. Public Health 2017    10.1016/j.puhe.2016.10.027 Iodine status and thyroid nodules in females: a comparison of Cyprus and Romania.
Konstantinos Makris Tsangari X., Andrianou X.D., Agapiou A., Mochalski P., Makris K.C. Benzene, toluene, ethylbenzene, o-, m-, and p-xylenes (BTEX) are ubiquitous outdoor and indoor air pollutants associated with both environmental and health effects. The objective of this exploratory study was to determine the magnitude and variability of urinary BTEX levels among residents of two areas located in the same city (Nicosia, Cyprus). The two areas differed with respect to their proximity to an industrial cluster and an intercity-highway. First morning urine voids were collected in the two urban areas (n = 48). The majority of participants were females (65%) and non-smokers (85%) with a mean age of 49 years. Median urinary BTEX levels were: 118 ng L-1, 124 ng L-1, 9 ng L-1, 29 ng L-1 and 28 ng L-1 for benzene, toluene, ethylbenzene, (p + m)-xylene and o-xylene, respectively. With the exception of benzene, participants from area 2 (closer to the industrial cluster and an intercity road than area 1) had significantly (p < 0.05) higher urinary BTEX levels than those from area 1 (regression analysis). The residence location (in area 2) was the sole significant (p < 0.05) predictor of urinary BTEX levels after adjusting for sex, smoking, age, body mass index, and educational level. Chemosphere 2017 10.1016/j.chemosphere.2017.01.043 spatial characteristics of urinary BTEX concentrations in the general population
Konstantinos Makris Andrianou X.D., Gängler S, Piciu A., Charisiadis P., Zira C., Aristidou K., Piciu D., Hauser R., Makris K.C. Environmental factors, such as exposures to thyroid-disrupting chemicals may contribute to thyroid nodular disease (TND) and altered thyroid function. We investigated the association between exposures to bisphenol A (BPA), its chlorinated derivatives (ClxBPA), and bisphenol F (BPF) with TND and thyroid measures in adult women. A case-control study in Cyprus and Romania (n = 212) was conducted, where cases were those with thyroid nodules (diameter >3mm), and controls without nodules. Serum TSH and free thyroxine and urinary levels of BPA, BPF and ClxBPA were measured using immunoassays and tandem mass spectrometry, respectively. The association between exposures to BPA compounds and TND, adjusting for age, BMI, thyroid hormones and urinary iodine was assessed using logistic regression. Linear regression was used to explore associations between urinary BPA, BPF and ClxBPA and serum thyroid hormones. With the exception of a chlorinated BPA compound (30%), the rest of bisphenols were quantified in 100% of urine samples. A positive and significant (p<0.05) association was observed between urinary BPA and serum TSH that remained after adjusting for urinary creatinine, age, BMI, study site and disease status. Our study found associations of urinary BPA with TSH but not with BPF or ClxBPA. PLoS One 2016 10.1371/journal.pone.0155237 Human exposores to bisphenol A, bisphenol F and chlorinated bisphenol A Deratives and Thyroid Function
Konstantinos Makris Makris K.C., Andrianou X.D., Charisiadis P., Burch J.B., Seth R.K., Ioannou A., Picolos M., Christophi C.A., Chatterjee S. Non-alcoholic fatty liver disease (NAFLD) is commonly diagnosed in the majority of obese patients with type 2 diabetes mellitus (T2DM). The objectives of this study were to: i) determine the association of urinary brominated THM (BrTHM) levels and T2DM disease status, and ii) investigate the association between urinary BrTHM levels and serum alanine aminotransferase (ALT) concentrations, often used as surrogate markers of NAFLD. A pilot case-control study was conducted in Nicosia, Cyprus (n=95). Cases were physician-diagnosed T2DM patients and controls were healthy individuals. Liver enzymes, leptin and TNF-α were measured in sera, while urinary THM levels were measured using tandem mass spectrometry. Among all study participants those with serum ALT levels above the median (17IU/L) had higher mean tribromomethane (TBM) concentrations compared to those with serum ALT below 17IU/L. A significant increase in the odds of having above the median serum ALT levels was observed for each unit increase in creatinine-unadjusted urinary TBM levels, along with BMI and past smoking, after adjusting for possible confounders, such as urinary creatinine, age, sex, and leptin; no other THM compound showed a significant association with serum ALT. The interplay between exposures to BrTHM and the initiation of key pathophysiological events relating to hepatic injury (ALT) and inflammation (leptin) was recognized via the use of selected biomarkers of effect. Environment International 2016 10.1016/j.envint.2016.04.012 association between exposures to brominated trihalomethanes hepatic injury and type 2 diabetes mellitus
Konstantinos Makris Piciu A., Andrianou X.D., Irimie A., Bălăcescu O., Zira C., BĂRBUş E., Peştean C., Aristeidou K., Theofanous T., Agathokleous M., Piciu D., Makris K.C. A pilot case-control study has been conducted in 2014-2015 in Romania and Cyprus. Cases were women with ultrasound-confirmed thyroid nodules of size >3mm. Controls were women without thyroid nodules after ultrasound confirmation. All participants provided blood samples for measurements of the thyroid stimulating hormone (TSH), free thyroxin (FT4), anti-thyroglobulin (ATg) and anti-thyroid peroxidase (ATPO); urine samples. Demographics, anthropometrics and other relevant information were provided through the administration of a questionnaire. In Romania we selected 51 patients with thyroid nodules (case group) and 41 without thyroid nodules (control group) and in Cyprus 57 cases, respectively 65 controls. After the statistical analysis of the data collected we observed statistically significant differences between the populations of the two countries regarding BMI and the value of the thyroid hormones and antibodies. Using the data observed in this study, differences were found between Cyprus and Romania among females with thyroid nodules the BMI, and the level of thyroid hormones had statistically significant differences. This study reports preliminary data, further analysis of environmental exposures to chemical factors that might have a certain influence over the thyroid in the two countries will follow. Clujul Mecial 2015 10.15386/cjmed-518. Investigation of thyroid nodules in the female popualtion in Cyprus and Romania
Konstantinos Makris Ioannou P., Charisiadis P., Andra S.S., Makris K.C. Non-iodo-containing trihalomethanes (TTHM) are frequently detected in chlorinated tap water and currently regulated against their carcinogenic potential. The main objective of this study was to determine the magnitude and variability of ITHM and TTHM levels and their corresponding daily intake estimates within the drinking water distribution systems of Limassol and Nicosia cities of Cyprus, using tap samples collected from individual households (n=37). In Limassol, mean household tap water ITHM and TTHM levels was 0.58 and 38 μg L(-1), respectively. Dichloroiodomethane (DCIM) was the dominant species of the two measured ITHM compounds accounting for 77% of total ITHM and in the range of 0.032 and 1.65 μg L(-1). The range of DCIM concentrations in Nicosia tap water samples was narrower (0.032 - 0.848 μg L(-1)). Mean total iodine concentration in tap water samples from the seaside city of Limassol was 15 μg L(-1) and approximately twice to those observed in samples from the mainland Nicosia city. However, iodine concentrations did not correlate with the ITHM levels. The calculated chronic daily intake rates of ITHM were low when compared with those of TTHM, but because of their widespread occurrence in tap water and their enhanced mammalian cell toxicity, additional research is warranted to assess the magnitude and variability of human ITHM exposures. The Science of the Total Environment 2016 10.1016/j.scitotenv.2015.10.031. Occurence and variability of iodinated trihalomethanes concentrations within two drinking-water distribution networks
Konstantinos Makris Botsaris G., Kanetis L., Slaný M., Parpouna C., Makris K.C. Microorganisms can survive and multiply in aged urban drinking water distribution systems, leading to potential health risks. The objective of this work was to investigate the microbial quality of tap water and molecularly identify its predominant cultivable microorganisms. Tap water samples collected from 24 different households scattered in the urban area of Limassol, Cyprus, were microbiologically tested following standard protocols for coliforms, E. coli, Pseudomonas spp., Enterococcus spp., and total viable count at 22 and 37 °C. Molecular identification was performed on isolated predominant single colonies using 16SrRNA sequencing. Approximately 85% of the household water samples were contaminated with one or more microorganisms belonging to the genera of Pseudomonas, Corynebacterium, Agrobacterium, Staphylococcus, Bacillus, Delftia, Acinetobacter, Enterococcus, Enterobacter, and Aeromonas. However, all samples tested were free from E. coli. This is the first report in Cyprus molecularly confirming specific genera of relevant microbial communities in tap water. Environmental monitoring and assessment 2015 10.1007/s10661-015-4957-9. Microbial quality and molecular identification of cultivable microorganisms isolated from an urban drinking water distribution system (Limassol, Cyprus)
Konstantinos Makris Andra S.S., Charisiadis P., Arora M., van Vliet-Ostaptchouk J.V., Makris K.C. The high reactivity of bisphenol A (BPA) with disinfectant chlorine is evident in the instantaneous formation of chlorinated BPA derivatives (ClxBPA) in various environmental media that show increased estrogen-activity when compared with that of BPA. The documented health risks associated with BPA exposures have led to the gradual market entry of BPA structural analogs. A suite of exposure sources to ClxBPA and BPA analogs in the domestic environment is anticipated to drive the nature and range of halogenated BPA derivatives that can form when residual BPA comes in contact with disinfectant in tap water and/or consumer products. The primary objective of this review was to survey all available studies reporting biomonitoring protocols of ClxBPA and structural BPA analogs (BPS, BPF, BPB, etc.) in human matrices. During the last decade, an increasing number of ecotoxicological, cell-culture and animal-based and human studies dealing with ClxBPA exposure sources and routes of exposure, metabolism and toxicity have been published. Up to date findings indicated the association of ClxBPA with metabolic conditions, such as obesity, lipid accumulation, and type 2 diabetes mellitus, particularly in in-vitro and in-vivo studies.  Environment International 2015 10.1016/j.envint.2015.09.011 Biomonitoring of human epxosures to chlorinated derivates and structural analogs of bisphenol A. 
Konstantinos Makris Andra S.S., Makris K.C. The objective of this exploratory post hoc analysis of our cross-sectional study's dataset was to evaluate the association between urinary levels of BPA and monochlorinated BPA (mono-ClBPA) with body mass index (BMI) in a random sample of 223 adults (≥18 years) from the general population in Cyprus.. We observed a relatively weak positive association between urinary mono-ClBPA and BMI, such as (i) 76 ng g(-1) in participants with above normal BMI (≥25 kg m(-2)) versus 55 ng g(-1) in those with normal BMI (<25 kg m(-2)) (P for mean difference = 0.053) and (ii) higher percentage of participants with above normal BMI in the high urinary mono-ClBPA tertile (63% in tertile 3 and 57% in tertile 2 versus 50% in tertile 1, P for trend = 0.056). A dichotomously-classified group analysis showed an increased odds ratio (OR) for higher BMI in the group with high creatinine-adjusted urinary levels of BPA and mono-ClBPA when compared with the participants group with low levels for both compounds [logistic model adjusted for gender and health status as potential confounders; adjusted OR (95% CI): 2.34 (1.10, 5.10), P = 0.027]. Measurements of both BPA and its trace chlorinated derivative in human matrices may be warranted for a comprehensive exposure assessment towards improving our understanding of their obesogenic effects. Journal of environmental science and health. Part A, Toxic/hazardous substances & environmental engineering 2015 10.1080/10934529.2015.1047674 Association betwee urinary levels of bisphenol A and it monochlorinated derivative and obesity 
Konstantinos Makris Papadakis E.N., Vryzas Z., Kotopoulou A., Kintzikoglou K., Makris K.C., Papadopoulou-Mourkidou E. A pesticide monitoring study covering the main rivers and lakes of Northern Greece (Macedonia, Thrace and Thessaly) was undertaken. A total of 416 samples were collected over a 1.5-year sampling period (September 1999- February 2001) from six rivers and ten lakes. The water samples were analyzed using an analytical method for 147 pesticides and their metabolites. Based on the pesticide survey results, a human health carcinogenic and non-carcinogenic risk assessment was conducted for adults and children.. Results showed that the herbicides metolachlor, prometryn, alachlor and molinate, were the most frequently detected pesticides (29%, 12.5%, 12.5% and 10%, respectively). They also exhibited the highest concentration values, often exceeding 1 μg/L. Chlorpyrifos ethyl was the most frequently detected insecticide (7%).. The highest concentrations were recorded during May-June period, right after pesticide application. Concentrations of six pesticides were above the maximum allowable limit of 0.1 μg/L set for drinking water. Alachlor, atrazine and a-HCH showed unacceptable carcinogenic risk estimates (4.5E-06, 4.6E-06 and 1.3E-04, respectively). Annual average concentrations of chlorpyriphos ethyl (0.031 μg L), dicofol (0.01 μg/L), dieldrin (0.02 μg/L) and endosulfan a (0.065 μg/L) exceeded the EU environmental quality standards. The risk quotient estimates for the insecticides chorpyrifos ethyl, diazinon and parathion methyl and herbicide prometryn were above acceptable risk values.  Ecotoxicology and environmental safety 2015 10.1016/j.ecoenv.2015.02.033 A pesticide monitoring survey in rivers and lakes of northern Greece and its human and ecotoxicological risk assessment
Konstantinos Makris Andra S.S., Kalyvas H., Andrianou X.D., Charisiadis P., Christophi C.A., Makris K.C. We evaluated the association between urinary monochlorinated BPA (mono-ClBPA) concentrations and the incidence of T2DM. In our cross-sectional study, we identified 20 adult participants (≥18 yr) who reported having T2DM (doctor-diagnosed) and 131 adults with normal health. First morning void urine samples were analyzed for total BPA and mono-ClBPA. Detection limits of the analytical method were 95 ng L(-1) for BPA and 32 ng L(-1) for mono-ClBPA. Multivariable logistic regression analyses and additive Bayesian network modeling were performed. After adjusting for age, gender, BMI, urinary total BPA and other confounders, the odds of having T2DM was 3.29 times higher (95% confidence interval, CI: 1.10, 11.4; P < 0.05) per unit increase in log-transformed and creatinine-adjusted urinary mono-ClBPA levels (n = 151); this relation did not hold for total BPA. The globally optimum Bayesian model corroborated the results of the logistic regression by expressing mono-ClBPA in the pathway of T2DM, and not for total BPA. An age-matched sensitivity analysis confirmed the increase in OR of T2DM by 3.04 times (95% CI: 1.10, 11.0; P < 0.05) per unit increase in log-transformed and creatinine-adjusted urinary mono-ClBPA concentration (n = 68). The urinary monochlorinated BPA derivative was significantly associated with T2DM, whereas the parent compound (total BPA) was not.  Journal of environmental science and health. Part A, Toxic/hazardous substances & environmental engineering 2015 10.1080/10934529.2015.981111 Preliminary evidence of the association between monochlorinated bisphenol A exposure and type 2 diabetes mellitus: a pilot study
Konstantinos Makris Andrianou X.D., Charisiadis P., Andra S.S., Makris K.C. A complex network of sources and routes of exposure to disinfection by-products (DBP), such as trihalomethanes (THM) has been driving the wide variability of daily THM intake estimates in environmental epidemiological studies. We hypothesized that the spatiotemporal variability of THM exposures could be differentially expressed with their urinary levels among residents whose households are geographically clustered in district-metered areas (DMA) receiving the same tap water. Each DMA holds unique drinking-water pipe network characteristics, such as pipe length, number of pipe leaking incidences, number of water meters by district, average minimum night flow and average daily demand. The present study assessed the spatial and seasonal variability in urinary THM levels among residents (n=310) of geocoded households belonging to two urban DMA of Nicosia, Cyprus, with contrasting water network properties. First morning urine voids were collected once in summer and then in winter. Results showed that the mean sum of the four urinary THM analytes (TTHM) was significantly higher during summer for residents of both areas. Linear mixed effects models adjusted for age, season and gender, illustrated spatially-resolved differences in creatinine-adjusted urinary chloroform and TTHM levels between the two studied areas, corroborated by differences observed in their pipe network characteristics.  Environmental research 2014 10.1016/j.envres.2014.09.015 Spatial and seasonal variability of urinary trihalimethanes concentrations in urban settings
Konstantinos Makris Charisiadis P., Andra S.S., Makris K.C., Christophi C.A., Skarlatos D., Vamvakousis V., Kargaki S., Stephanou G.E. The objectives were to: (i) characterize the distribution of water trihalomethanes (THM). concentrations in households from two district-metered areas (DMAs) with contrasting UDWDS characteristics sampled in two seasons (summer and winter), and (ii) assess the within- and between-household, spatial variability of water THM accounting for urban drinking-water distribution systems (UDWDS characteristics (household distance from chlorination tank and service pipe leaking incidences). A total of 383 tap water samples were collected from 193 households located in two DMAs within the UDWDS of Nicosia city, Cyprus, and analyzed for the four THM species. The higher intraclass correlation coefficient (ICC) values for water tribromomethane (TBM) (0.75) followed by trichloromethane (0.42) suggested that the two DMAs differed with respect to these analytes. On the other hand, the low ICC values for total THM levels between the two DMAs suggested a large variance between households. The effect of households nested under each DMA remained significant (p<0.05) for TBM (not for the rest of the THM species) in the multivariate mixed-effect models, even after inclusion of pipe network characteristics. Our results could find use by water utilities in overcoming techno-economic difficulties associated with the large spatiotemporal variability of THM, while accounting for the influence of UDWDS features at points of water use. The Science of the Total Environment 2015 10.1016/j.scitotenv.2014.10.071 Spatial and seasonal variability of tap water disinfection by-products within distribution pipe networks
Konstantinos Makris Andra S.S., Charisiadis P., Karakitsios S., Sarigiannis D.A., Makris K.C. Domestic cleaning has been proposed as a determinant of trihalomethanes (THMs) exposure in adult females. g. In a recent cross-sectional study (n = 382) in Cyprus [41 children (< 18 y) and 341 adults (≥ 18 y)], we identified 29 children who met the study's inclusion criteria. Linear regression models were applied to understand the association between children sociodemographic variables, their individual practices influencing ingestion and noningestion exposures to ΣTHMs, and their urinary THMs levels. Among the children-specific variables, age alone showed a statistically significant inverse association with their creatinine-adjusted urinary ΣTHMs (rS = -0.59, p < 0.001). A positive correlation was observed between urinary ΣTHMs (ng g(-1)) of children and matched-mothers (rS = 0.52, p = 0.014), but this was not the case for their matched-fathers (rS = 0.39, p = 0.112). Time spent daily by the matched-mothers for domestic mopping, toilet and other cleaning activities using chlorine-based cleaning products was associated with their children's urinary THMs levels (rS = 0.56, p = 0.007). Our findings highlighted the influence of mothers' domestic cleaning activities towards enhancing passive THMs exposures of their children. The duration of such activities could be further tested as a valid indicator of children's THMs body burden. Environmental research 2015 10.1016/j.envres.2014.10.018 Passive exposures of children to volatile trihalomethanes during domestic cleaning activities of their parents
Konstantinos Makris Andra S.S., Makris K.C., Charisiadis P., Costa C.N. Potable water samples (N = 74) from 19 zip code locations in a region of Greece were profiled for 13 trace elements composition using inductively coupled plasma mass spectrometry. The primary objective was to monitor the drinking water quality, while the primary focus was to find novel associations in trace elements occurrence that may further shed light on common links in their occurrence and fate in the pipe scales and corrosion products observed in urban drinking water distribution systems. Except for arsenic at two locations and in six samples, rest of the analyzed elements was below maximum contaminant levels. Further, we attempted to hierarchically cluster trace elements based on their covariances resulting in two groups; one with arsenic, antimony, zinc, cadmium, and copper and the second with the rest of the elements. The grouping trends were partially explained by elements' similar chemical activities in water, underscoring their potential for co-accumulation and co-mobilization phenomena from pipe scales into finished water. Profiling patterns of trace elements in finished water could be indicative of their load on pipe scales and corrosion products, with a corresponding risk of episodic contaminant release. Speculation was made on the role of disinfectants and disinfection byproducts in mobilizing chemically similar trace elements of human health interest from pipe scales to tap water.  Environmental monitoring and assessment 2014 10.1007/s10661-014-3928-x Co-occurence profiles of trace elements in potable water systems: a case study
Konstantinos Makris Kalyvas H., Andra S.S., Charisiadis P., Karaolis C., Makris K.C. Low-dose health effects of BPA in the presence of BPA metabolites of chlorinated structure that may exert larger estrogenic effects than those of their parent compound. Our objective was to investigate the influence of typical household cleaning activities (dishwashing, toilet cleaning, mopping, laundry, etc.) on the magnitude and variability of urinary total BPA and mono-ClBPA levels in the general adult population. A cross-sectional study (n=224) included an adult (≥18 years) pool of participants from the general population of Nicosia, Cyprus. First morning urine voids were collected, and administered questionnaires included items about household cleaning habits, demographics, drinking water consumption rates and water source/usage patterns. Urinary concentrations of total BPA (range: 0.2-82 μg L(-1)), mono-ClBPA (16-340 ng L(-1)), and total trihalomethanes (0.1-5.0 μg L(-1)) were measured using gas chromatography coupled with triple quadrupole mass spectrometry and large volume injection. Linear multiple regression analysis revealed that dishwashing along with age and gender (females) were able to predict urinary mono-ClBPA levels (ng g(-1)), even after adjusting for covariates; this was not the case for urinary total BPA levels (ng g(-1)). Significant (p<0.001) association was observed between urinary mono-ClBPA and THM levels, underlying the important role of disinfectant (chlorine) in promoting formation of both ClBPA and THM.  The Science of the Total Environment 2014 10.1016/j.scitotenv.2014.04.072 Influence of household cleaning practices on the magnitude and variability of urinary monochlorinated bisphenol A.
Konstantinos Makris Andra S.S., Charisiadis P., Makris K.C. THM are formed within disinfected tap water and their health effects, under research, range from cancer to adverse reproductive outcomes. The objective of this exploratory analysis was to address obesity-mediated associations between urinary concentrations of brominated THM and incidences of T2DM in a Cypriot adult population (n=326). First morning urine voids were collected once during summer and another time during winter while a detailed questionnaire was administered to participants. Creatinine-adjusted urinary Br-THM analyte concentrations were significantly (p<0.05) higher in T2DM cases when compared with those in healthy individuals. Multivariate logistic regression models adjusted for potential confounders showed that participants with ≥30 kg m(-2) BMI were at a higher T2DM risk (OR=8.42, 95% CI: 1.97, 45.5; p<0.01) when compared with that of normal weight participants (<25 kg m(-2)). About 4 times higher risk for developing T2DM was observed for individuals in the upper tertile of urinary Br-THM levels (OR=3.99, 95% CI: 1.07, 19.7; p<0.05) when compared with the lower tertile participants. Among the participants with BMI≥25 kg m(-2), urinary Br-THM levels were significantly (p<0.001) higher in diabetics than in healthy individuals. Ingestion and non-ingestion exposures to Br-THM deserve careful consideration in relevant epidemiological studies, as a possible environmental risk factor of T2DM. The Science of the Total Environment 2014 10.1016/j.scitotenv.2014.03.075 Obesity-mediated assocation between exposure to brominated trihalomethanes and type 2 diabetes mellitus: an exploratory analysis
Konstantinos Makris Andra S.S., Makris K.C. Human biomonitoring studies for water contaminants are often accompanied by surveys relying solely on total drinking water consumption rates, thus, failing to account for specific water sources (bottled and tap water) and use habits, such as water used for preparing cold/hot beverages (coffee, tea, juice, etc.). Despite the extensive use of bisphenol A (BPA) in polycarbonate (PC)-based water contact materials, rarely do BPA biomonitoring studies focus on various PC water uses and sources. Better resolved water consumption rates could reduce the uncertainty associated with surrogate daily BPA intake estimates using fine-tuned surveys. This approach provided a proof of concept on inclusion of water consumption from various sources and uses into estimates of daily intake for water contaminants like BPA found in water-contact materials.  Journal of water and health 2014 10.2166/wh.2013.068. Incorporating potable water sources and use habits into surveys that improve surrogate exposure for water contaminants: the case of bisphenol A. 
Konstantinos Makris Charisiadis P., Makris K.C. Because of the plethora of exposure sources and routes through which humans are exposed to trihalomethanes (THM), the limitation of their short half-lives could be overcome, if a highly sensitive method was available to quantify urinary THM concentrations at sub-ppb levels. The objective of this study was to develop a fast and reliable method for the determination of the four THM analytes in human urine. A sensitive methodology was developed for THM in urine samples using gas chromatography coupled with triple quadrupole mass spectrometry (GC-QqQ-MS/MS) promoting its use in epidemiological and biomonitoring studies. The proposed methodology enjoys limits of detection similar to those reported in the literature (11-80 ng L(-1)) and the advantages of small initial urine volumes (15 mL) and fast analysis per sample (12 min) when compared with other methods. This is the first report using GC-QqQ-MS/MS for the determination of THM in urine samples. Because of its simplicity and less time-consuming nature, the proposed method could be incorporated into detailed (hundreds of participants' urine samples) exposure assessment protocols providing valuable insight into the dose-response relationship of THM and cancer or pregnancy anomalies Journal of chromatography. B, Analytical technologies in the biomedical and life sciences 2014 10.1016/j.jchromb.2013.11.060 A sensitive and fast method for trihalomethanes in urine using gas chromatography-tripe quadrupole mass spectrometry
Konstantinos Makris Andra S.S., Makris K.C., Botsaris G., Charisiadis P., Kalyvas H., Costa C.N. Changes in disinfectant type could trigger a cascade of reactions releasing pipe-anchored metals/metalloids into finished water. However, the effect of pre-formed disinfection by-products on the release of sorbed contaminants (arsenic-As in particular) from drinking water distribution system pipe scales remains unexplored. A bench-scale study using a factorial experimental design was performed to evaluate the independent and interaction effects of trihalomethanes (TTHM) and haloacetic acids (HAA) on arsenic (As) release from either scales-only or scale-biofilm conglomerates (SBC) both anchored on asbestos/cement pipe coupons. A model biofilm (Pseudomonas aeruginosa) was allowed to grow on select pipe coupons prior experimentation. Either TTHM or HAA individual dosing did not promote As release from either scales only or SBC, detecting <6 μg AsL(-1) in finished water. In the case of scales-only coupons, the combination of the highest spike level of TTHM and HAA significantly (p<0.001) increased dissolved and total As concentrations to levels up to 16 and 95 μg L(-1), respectively. Similar treatments in the presence of biofilm (SBC) resulted in significant (p<0.001) increase in dissolved and total recoverable As up to 20 and 47 μg L(-1), respectively, exceeding the regulatory As limit.  The Science of the Total Environment 2014 10.1016/j.scitotenv.2013.11.045 Evidence of arsenic release promoted by disinfection by-products within drinking-water distrinbution systems
Konstantinos Makris Charisiadis P., Andra S.S., Makris K.C., Christodoulou M., Christophi C.A., Kargaki S., Stephanou E.G. We examined the relation between household cleaning activities (washing dishes/clothes, mopping, toilet cleaning, and washing windows/surfaces) and urinary THM concentrations accounting for water sources, uses, and demographics. A cross-sectional study (n = 326) was conducted during the summer in Nicosia, Cyprus, linking household addresses to the geocoded public water pipe network, individual household tap water, and urinary THM measurements. Household tap water THM concentrations ranged between 3-129 μg L(-1), while the median (Q1, Q3) creatinine-adjusted urinary THM concentration in females (669 ng g(-1) (353, 1377)) was significantly (p < 0.001) higher than that in males (399 ng g(-1), (256, 681)). Exposure assessment, based on THM exposure equivalency units, showed that hand dishwashing, mopping, and toilet cleaning significantly (p < 0.001) increased urinary THM levels. The effect of dishwashing by females ≥36 y of age remained significant, even after adjusting for potential confounders. No significant (p > 0.05) association was observed between ingestion-based THM exposure equivalency units and urinary THM. Noningestion routes of THM exposures during performance of routine household cleaning activities were shown for the first time to exert a major influence on urinary THM levels. It is warranted that future pregnancy-birth cohorts include monitoring of noningestion household THM exposures in their study design. Environmental science & technology 2014 10.1021/es404220z Households cleaning activities as noningestion exposure determinants of urinary trihalomethanes
Konstantinos Makris Makris K.C., Andra S.S. The objectives of this scientific commentary were to (i) highlight the extent of appraisal of water contamination in exposure assessment studies of in pregnancy-birth cohorts (PBC), worldwide, and (ii) propose recommendations to increase awareness of emerging water-related risks through their improved representation into PBC study designs in urban centers. Three scientific literature databases (Scopus, PubMed, and Web of Science) were used for a systematic search on worldwide PBC and their publications that considered water contamination and health outcomes. Publicly-available e-databases (ENRIECO, BIRTHCOHORTS, and CHICOS) were also employed for detailed exploration of existing European Union (EU)-based PBC. Out of the 76 PBC identified in the EU territory, only 12 of them incorporated water contamination into their study designs. Among which only 6 PBC published scientific articles that either included data on water contamination and/or water intake estimates. Trihalomethanes but not other disinfection by-products were mostly studied in the PBC around the globe, while fluoride, atrazine, perfluorinated compounds, tetrachloroethylene, and lead were studied to a lesser extent as water contaminants. It appears that chemical-based water contamination and corresponding human exposures represent a largely underappreciated niche of exposure science pertaining to pregnant mother and children's health in PBC. The Science of the Total Environment 2014 10.1016/j.scitotenv.2013.08.012 Limited representation of drinking-water contaminents in pregancy-birth cohorts
Konstantinos Makris Das P., Sarkar D., Makris K.C., Punamiya P., Datta R. One of the major challenges in developing an effective phytoremediation technology for 2,4,6-trinitrotoluene (TNT) contaminated soils is limited plant uptake resulting from low solubility of TNT. Our preliminary greenhouse experiments using urea were also very promising, but further characterization of the performance of urea in highly-complex soil-solution was necessary. The present study investigated the natural retention capacity of four chemically variant soils and optimized the factors influencing the effectiveness of urea in enhancing TNT solubility in the soil solutions. Results show that the extent of TNT sorption and desorption varies with the soil properties, and is mainly dependent on soil organic matter (SOM) content. Hysteretic desorption of TNT in all tested soils suggests irreversible sorption of TNT and indicates the need of using an extractant to increase the release of TNT in soil solutions. Urea significantly (p<0.0001) enhanced TNT extraction from all soils, by increasing its solubility at the solid/liquid interface. Soil organic matter content and urea application rates showed significant effects, whereas pH did not exert any significant effect on urea catalysis of TNT extraction from soil. The optimum urea application rates (125 or 350 mg kg(-1)) for maximizing TNT extraction were within the limits set by the agronomic fertilizer-N rates used for major agricultural crops.  Chemosphere 2013 10.1016/j.chemosphere.2013.06.028 Effectiveness of urea in enhancing the extractability of 2,4,6-trinitrotoluene from chemically variant soils
Konstantinos Makris Makris K.C., Andra S.S., Jia A., Herrick L., Christophi C.A., Snyder S.A., Hauser R. Little attention has been paid to bisphenol A (BPA) intake from packaged water consumption (PC water dispensers), especially during summer weather conditions. We determined the magnitude and variability of urinary BPA concentrations during summer in 35 healthy individuals largely relying upon PC packaged water to satisfy their potable needs. We used liquid chromatography-tandem mass spectrometry to measure urinary BPA concentrations. A questionnaire was administered in July/August and a spot urine sample was collected on the same day and 7 days after the completion of the interview (without intervention). Linear regression was performed to assess the association of variables, such as water consumption from different sources, on urinary BPA levels for the average of the two urine samples. A significant positive association (p = 0.017) was observed between PC water consumption and urinary BPA levels in females, even after adjusting for covariates in a multivariate regression model. The geometric mean of daily BPA intake back-calculated from urinary BPA data was 118 ng · (kg bw)(-1) · day(-1), nearly double the average intake levels observed in biomonitoring studies worldwide. High urinary BPA levels were partially ascribed to summer's high PC water consumption and weather characteristics (high temperatures, >40 °C; very high UV index values, >8), which could be causing BPA leaching from PC Environmental science & technology 2013 10.1021/es304038k Association between water consumption from polycarbonate containers and bisphenol A intake during harsh environmental conditions in summer
Konstantinos Makris Makris K.C., Andra S.S., Herrick L., Christophi C.A., Snyder S.A., Hauser R. This study set out to investigate the relationship between drinking-water source, use characteristics, and urinary Sb concentrations (U-Sb) accompanied with survey responses of a healthy (n=35) Cypriot participant pool. One spot urine sample was collected during administration of questionnaire, while a second spot urine sample was collected from the same individual about 7 days later. Urinary and water Sb concentrations were measured with an inductively coupled plasma mass spectrometer. Survey responses showed that bottled water summed over various volumes and plastic types, such as polycarbonate and PET contributed to an average 61% of daily water consumption. Water sources such as tap, mobile stations (explained in a following section), and well water contributed to 24%, 14%, and 2% of an individual's daily water consumption pattern, respectively. Average daily potable water use of both bottled and tap water by individuals consisted of 65% drinking-water, while the remaining 35% was water used for preparing cold and hot beverages, such as, tea, coffee, and juices. A significant (P=0.02) association between per capita water consumption from PET bottles and urinary creatinine-unadjusted concentrations was observed, but this relationship did not remain after inclusion of covariates in a multivariate regression model. In the creatinine-adjusted regression model, only gender (female) was a significant (P<0.01) predictor of U-Sb, after adjusting for several covariates.. Journal of exposure sciecnce & environmental epidemiology 2013 10.1038/jes.2012.104 Association of drinking-water source and use characteristics with urinary antimony concentrations
Konstantinos Makris Andra S.S., Makris K.C., Christophi C.A., Ettinger A.S. on-carcinogenic effects in low-level (< 100 μgL(-1)) arsenic (As)-impacted populations, such as the development and progression of type-2 diabetes mellitus (T2DM), are often neglected given the primary emphasis of public health authorities on As carcinogenicity. We gathered studies reporting urinary biomarkers of As exposure (U-As) and biomarkers associated with T2DM and its complications (U-T2DM), such as renal damage, oxidation stress, low-grade inflammation, and endothelial damage. Studied U-T2DM biomarkers were: 8-hydroxy-2'deoxyguanosine, N-acetyl-β-d-glucosaminidase, β2-microglobulin, and albumin. Data was expressed as: either arithmetic means and standard deviations, or geometric means and geometric standard deviations, or correlation coefficients of U-As and U-T2DM. Urinary As concentrations were consistently associated with the aforementioned biomarkers of T2DM pathologic complications. Despite the limited selectivity of the selected T2DM biomarkers, a per unit change in As exposure level was reflected in the corresponding T2DM biomarker urinary concentrations. Our systematic review provides new evidence on the role of environmental As exposures influencing the T2DM disease process. Additional epidemiologic studies onto the association between As and T2DM should incorporate both urinary As and T2DM biomarkers, as suggested in this study, in order to evaluate subclinical effects of low-level As exposures. International journal of hygiene and environmental health 2013 10.1016/j.ijheh.2012.07.001 Delineating the degree of association between biomarkers of arsenic exposure and type-2 diabetes mellitus
Konstantinos Makris Andra S.S., Makris K.C. The globally escalating thyroid nodule incidence rates may be only partially ascribed to better diagnostics, allowing for the assessment of environmental risk factors on thyroid disease. Endocrine disruptors or thyroid-disrupting chemicals (TDC) like bisphenol A, phthalates, and polybrominated diphenyl ethers are widely used as plastic additives in consumer products. This comprehensive review studied the magnitude and uncertainty of TDC exposures and their effects on thyroid hormones for sensitive subpopulation groups like pregnant women, infants, and children. Our findings qualitatively suggest the mixed, significant (α = 0.05) TDC associations with natural thyroid hormones (positive or negative sign). Future studies should undertake systematic meta-analyses to elucidate pooled TDC effect estimates on thyroid health indicators and outcomes. Journal of environmental science and health. Part C, Environmental carcinogenesis & ecotoxicology reviews 2012 10.1080/10590501.2012.681487 Thyroid disrupting chemicals in plastic additives and thyroid health
Konstantinos Makris Makris K.C., Christophi C.A., Paisi M., Ettinger A.S. A preliminary study was undertaken in a community of Cyprus where low-level arsenic (As) concentrations were recently detected in the groundwater that was chronically used to satisfy potable needs of the community. The main objective of the study was to assess the degree of association between orally-ingested As and self-reported type-2 diabetes mellitus (DM) in 317 adult (≥18 years old) volunteers. Cumulative lifetime As exposure (CLAEX) (mg As) was calculated using the median As concentrations in water, individual reported daily water consumption rates, and lifetime exposure duration. Logistic regression models were used to model the probability of self-reported DM and calculate odds ratios (OR) in univariate and multivariate models. Significantly higher (p < 0.02) CLAEX values were reported for the diabetics (median = 999 mg As) versus non-diabetics (median = 573 mg As), suggesting that As exposure could perhaps be related to the prevalence of DM in the study area, which was 6.6%. The OR for DM, comparing participants in the 80th versus the 20th percentiles of low-level As CLAEX index values, was 5.0 (1.03, 24.17), but after adjusting for age, sex, smoking, education, and fish consumption, the As exposure effect on DM was not significant. BMC public health 2012 10.1186/1471-2458-12-334 A preliminary assessment of low level arsenic exposure and diabetes mellitus in Cyprus
Konstantinos Makris Economides C., Liapi M., Makris K.C. In addition to diet-based vectors of disease, the contribution of water-borne zoonotic agents to gastrointestinal illnesses may be significant, but this has yet to be investigated for Cyprus. Our main objective was to evaluate antibiotic resistance patterns of Salmonella and Escherichia coli in groundwater samples collected at confined animal feeding operations. This is the first report on the occurrence of antibiotic-resistant Salmonella and E. coli strains in the groundwater of Cyprus. Most of Salmonella isolates belonged to the subgroup enterica, whereas none of the E. coli isolates expressed the verotoxin-encoding gene. Out of 27 isolated Salmonella strains, nearly half of them were resistant to at least one or more antibiotic, whereas the highest resistance was exhibited by sulphamethoxazole (85%), followed by streptomycin (39%), and tetracycline (31%). For the E. coli isolates, nearly a third of them showed resistance to at least one antibiotic, whereas the selection of antibiotic resistance was equal among sulphamethoxazole, tetracycline and streptomycin (20%). This study demonstrated that Salmonella and E. coli in groundwater could pose a public health risk via oral ingestion of contaminated water. Environmental geochemistry and health 2012 10.1007/s10653-012-9450-6 Antibiotic resistance patterns of Salmonella and Escherichia coli in the groundwater of Cyprus
Konstantinos Makris Andra S.S., Makris K.C., Shine J.P., Lu C. A market-representative basket survey of bottled water was initiated in Boston, USA supermarkets. Bottled water classes sampled were: i) non-carbonated (NCR), ii) carbonated (CR), and iii) non-carbonated and enriched (NCRE). Plastic bottle materials sampled were: polyethylene terephthalate (PET), high-density polyethylene (HDPE), polystyrene (PS), and polycarbonate (PC). Storage conditions for the 31 bottled water samples were: 23°C temperature, no-shaking and 12h/12h light/dark for 60days of equilibration. Average Br and Sb concentrations after 60-days of storage followed the order of NCR<CR=NCRE, and NCR<CR<NCRE, respectively, suggesting that the presence of dissolved carbon dioxide in CR samples coupled to additions of flavors and color to NCRE could explain the elevated leaching of Br and Sb. Combining all bottled water classes and plastic material types, a highly significant (p<0.001) correlation was observed between log-transformed soluble Br and Sb concentrations, suggesting similar leaching behavior. Among samples with the highest soluble Br concentrations, BDE-209 congener was qualitatively confirmed in three out of four bottled water samples. The PC, HDPE, and PS samples exhibited significantly (p<0.05) lower Sb and Br leaching than PET. Upon quantitative validation of PBDE leaching from certain plastic bottles into water, a revisit to existing PBDE exposure assessment reports will be deemed necessary. Environment International 2012 10.1016/j.envint.2011.08.007 Co-leaching of brominated compounds and antimony from bottled water
Konstantinos Makris Andra S.S., Makris K.C., Shine J.P. The aim is to investigate the magnitude and variability of antimony (Sb) and bromine (Br) leaching from reused plastic containers (polyethylene terephthalate, PET; and polycarbonate, PC) subject to UV and/or temperature-driven disinfection. The overall objective of this study was to determine the main and interactive effects of temperature, UV exposure duration, and frequency of bottle reuse on the extent of leaching of Sb and Br from plastic bottles into water. Regardless of UV exposure duration, frequency of reuse (up to 27 times) was the major factor that linearly increased Sb leaching from PET bottles at all temperatures tested (13-47 °C). Leached Sb concentrations (∼360 ng L(-1)) from the highly reused (27 times) PET bottles (minimal Sb leaching from PC bottles, <15 ng L(-1)) did not pose a serious risk to human health according to current daily Sb acceptable intake estimates. Leached Br concentrations from both PET and PC containers (up to ∼15 μg L(-1)) did not pose a consumer health risk either, however, no acceptable daily dose estimates exist for oral ingestion of organo-brominated, or other plasticizers/additives compounds if they were to be found in bottled water at much lower concentrations. Water research 2011 10.1016/j.watres.2011.10.001 Frequency of use controls chemical leaching from drinking-water containers subject to disinfection
Konstantinos Makris Linos A., Petralias A., Christophi C.A., Christoforidou E., Kouroutou P., Stoltidis M., Veloudaki A., Tzala E., Makris K.C., Karagas M.R. Hexavalent chromium is a known carcinogen when inhaled, but its carcinogenic potential when orally ingested remains controversial. Water contaminated with hexavalent chromium is a worldwide problem. An ecological mortality study within the Oinofita region of Greece, where water has been contaminated with hexavalent chromium. We calculated gender, age, and period standardized mortality ratios (SMRs) for all deaths, cancer deaths, and specific cancer types of Oinofita residents over an 11-year period (1999 - 2009), using the greater prefecture of Voiotia as the standard population. The SMR for all cause mortality was 98 (95% CI 89-107) and for all cancer mortality 114 (95% CI 94-136). The SMR for primary liver cancer was 1104 (95% CI 405-2403, p-value < 0.001). Furthermore, statistically significantly higher SMRs were identified for lung cancer (SMR = 145, 95% CI 100-203, p-value = 0.047) and cancer of the kidney and other genitourinary organs among women (SMR = 368, 95% CI 119-858, p-value = 0.025). Elevated SMRs for several other cancers were also noted, but these did not reach statistical significance. Elevated cancer mortality in the Oinofita area of Greece supports the hypothesis of hexavalent chromium carcinogenicity via the oral ingestion pathway of exposure. Further studies are needed to determine whether this association is causal, and to establish preventive guidelines and public health recommendations. Environmental health: a global access science source 2011 10.1186/1476-069X-10-50 Oral ingestion of hexavalent chromium through drinking water and cancer mortality in an industrial area of Greece- and ecological study
Konstantinos Makris Andra S.S., Makris K.C. Cigarette and STP are important sources of TSNA to water supplies.  Knowledge on the occurrence and removal of TSNA in water bodies is lacking. Worst-case scenario predicts detectable TSNA levels in wastewater influent. Cancer risk potency of TSNA is similar to that of highly toxic alkyl nitrosamines, such as NDMA. Research is needed to determine TSNA removal efficiencies of wastewater treatments and the quantification of TSNA entry to the drinking-water cycle. If present in drinking water, TSNA concentrations will be relatively low, but the relative health risk remains unexplored, especially when TSNA concentrations in water are expected to increase with STP consumption in the following years. In-vivo experiments showed the carcinogenicity of TSNA in animal models, but epidemiologic studies are still lacking.  Environment International 2011 10.1016/j.envint.2010.11.003 Tabacco-specific nitrosamines in water: an unexplored environmental health risk
Andri Panayiotou Schmidt, A.F.aecucvEmail Author,  Swerdlow, D.I.af,  Holmes, M.V.kl,  Patel, R.S.aen,  Fairhurst-Hunter, Z.m,  Lyall, D.M.o,  Hartwig, F.P.r,  Horta, B.L.r,  Hyppönen, E.suv,  Power, C.u,  Moldovan, M.tw,  van Iperen, E.xy,  Hovingh, G.K.z,  Demuth, I.abac,  Norman, K.ab,  Steinhagen-Thiessen, E.ab,  Demuth, J.ad,  Bertram, L.gae,  Liu, T.afag,  Coassin, S.ah,  Willeit, J.ai,  Kiechl, S.ai,  Willeit, K.ai,  Mason, D.aj,  Wright, J.aj,  Morris, R.ak,  Wanamethee, G.b,  Whincup, P.al,  Ben-Shlomo, Y.ak,  McLachlan, S.am,  Price, J.F.am,  Kivimaki, M.c,  Welch, C.c,  Sanchez-Galvez, A.c,  Marques-Vidal, P.ao,  Nicolaides, A.hap,  Panayiotou, A.G.aq,  Onland-Moret, N.C.ar,  van der Schouw, Y.T.ar,  Matullo, G.atau,  Fiorito, G.atau,  Guarrera, S.atau,  Sacerdote, C.avaw,  Wareham, N.J.ax,  Langenberg, C.ax,  Scott, R.ax,  Luan, J.ax,  Bobak, M.c,  Malyutina, S.ayaz,  Pająk, A.ba,  Kubinova, R.bb,  Tamosiunas, A.bc,  Pikhart, H.c,  Husemoen, L.L.N.bd,  Grarup, N.be,  Pedersen, O.be,  Hansen, T.be,  Linneberg, A.bdbfbg,  Simonsen, K.S.bd,  Cooper, J.d,  Humphries, S.E.d,  Brilliant, M.bh,  Kitchner, T.bh,  Hakonarson, H.bi,  Carrell, D.S.bj,  McCarty, C.A.bk,  Kirchner, H.L.bl,  Larson, E.B.bm,  Crosslin, D.R.bm,  de Andrade, M.bn,  Roden, D.M.bo,  Denny, J.C.bp,  Carty, C.bq,  Hancock, S.br,  Attia, J.br,  Holliday, E.br,  O'Donnell, M.bs,  Yusuf, S.bs,  Chong, M.bs,  Pare, G.bs,  van der Harst, P.xbtbu,  Said, M.A.bt,  Eppinga, R.N.bt,  Verweij, N.bt,  Snieder, H.bv,  Christen, T.bw,  Mook-Kanamori, D.O.bw,  Gustafsson, S.bx,  Lind, L.bx,  Ingelsson, E.bxbybz,  Pazoki, R.ca,  Franco, O.ca,  Hofman, A.ca,  Uitterlinden, A.cb,  Dehghan, A.jca,  Teumer, A.cccg,  Baumeister, S.ccch,  Dörr, M.cdcg,  Lerch, M.M.ce,  Völker, U.cfcg,  Völzke, H.cccg,  Ward, J.o,  Pell, J.P.o,  Smith, D.J.o,  Meade, T.ci,  Maitland-van der Zee, A.H.aacj,  Baranova, E.V.cj,  Young, R.p,  Ford, I.p,  Campbell, A.an,  Padmanabhan, S.q,  Bots, M.L.ar,  Grobbee, D.E.ar,  Froguel, P.ick,  Thuillier, D.ck,  Balkau, B.cl,  Bonnefond, A.ick,  Cariou, B.cm,  Smart, M.cn,  Bao, Y.cn,  Kumari, M.cn,  Mahajan, A.m,  Ridker, P.M.co,  Chasman, D.I.co,  Reiner, A.P.cp,  Lange, L.A.cq,  Ritchie, M.D.crcs,  Asselbergs, F.W.aexaras,  Casas, J.-P.e,  Keating, B.J.ct,  Preiss, D.kl,  Hingorani, A.D.ae,  Sattar, N.q View additional authors.   The Lancet Diabetes and Endocrinology 2017 5(2):97-105  PCSK9 genetic variants and risk of type 2 diabetes: a mendelian randomisation study
Andri Panayiotou Elena Hadjimbei, George Botsaris, Vassilis Gekas, and Andrie G. Panayiotou   Journal of Nutrition and Metabolism  2016 http://dx.doi.org/10.1155/2016/2742841 Adherence to the Mediterranean Diet and Lifestyle Characteristics of University Students in Cyprus: A Cross-Sectional Survey
Andri Panayiotou Stavri Zinonos, Theodora Zachariadou, Savvas Zannetos, Andrie G. Panayiotou and Andreas Georgiou   Tobacco Induced Diseases 2016 14 https://doi.org/10.1186/s12971-016-0079-6 Smoking prevalence and associated risk factors among healthcare professionals in Nicosia general hospital, Cyprus: a cross-sectional study
Andri Panayiotou Nicolaides A, Panayiotou AG   JACC 2016 11(67):1275-77 Editorial: Screening for Atherosclerotic Cardiovascular Risk Using Ul¬trasound
Andri Panayiotou Kousios A, Kouis P and Panayiotou AG   Int J Nephrol  2016 dx.doi. org/10.1155/2016/9498013  Matrix Metalloproteinases and subclinical atheroscle¬rosis in Chronic Kidney Disease: A systematic review
Andri Panayiotou Panayiotou AG   Curr Vasc Pharmacol 2015 13(6):699-700 Editorial: Financial Crisis, Drug Compliance and Cardiovascular Health-the GREECS Case? 
Andri Panayiotou Panayiotou AG, Griffin M, Kouis P, Nicolaides AN   Int Angiol 2015 Oct;34(5):437-44. Epub 2015 Feb 12  Comparison between Insulin Resistance in¬dices and carotid and femoral atherosclerosis: A cross-sectional population study
Andri Panayiotou Holmes MV, Dale CE, Zuccolo L, Silverwood RJ, Guo Y, Ye Z, Prieto-Merino D, Dehghan A, Trompet S, Wong A, Cavadino A, Drogan D, Padmanabhan S, Li S, Yesupriya A, Leusink M, Sundstrom J, Hubacek JA, Pikhart H, Swerdlow DI, Panayiotou AG, Borinskaya SA, Finan C, Shah S, Kuchenbaecker KB, Shah T, En¬gmann J, Folkersen L, Eriksson P, Ricceri F, Melander O, Sacerdote C, Gamble DM, Rayaprolu S, Ross OA, McLachlan S, Vikhireva O, Sluijs I, Scott RA, Adamkova V, Flicker L, Bockxmeer FM, Power C, Marques- Vidal P, Meade T, Marmot MG, Ferro JM, Paulos-Pinheiro S, Humphries SE, Talmud PJ, Mateo Leach I, Verweij N, Linneberg A, Skaaby T, Doevendans PA, Cramer MJ, van der Harst P, Klungel OH, Dowling NF, Dominiczak AF, Kumari M, Nicolaides AN, Weikert C, Boeing H, Ebrahim S, Gaunt TR, Price JF, Lannfelt L, Peasey A, Kubinova R, Pajak A, Malyutina S, Voevoda MI, Tamosiunas A, Maitland-van der Zee AH,
Norman PE, Hankey GJ, Bergmann MM, Hofman A, Franco OH, Cooper J, Palmen J, Spiering W, de Jong PA, Kuh D, Hardy R, Uitterlinden AG, Ikram MA, Ford I, Hyppönen E, Almeida OP, Wareham NJ, Khaw KT, Hamsten A, Husemoen LL, Tjønneland A, Tolstrup JS, Rimm E, Beulens JW, Verschuren WM, Onland-Moret NC, Hofker MH, Wannamethee SG, Whincup PH, Morris R, Vicente AM, Wat¬kins H, Farrall M, Jukema JW, Meschia J, Cupples LA, Sharp SJ, Fornage M, Kooperberg C, LaCroix AZ, Dai JY, Lanktree MB, Siscovick DS, Jorgenson E, Spring B, Coresh J, Li YR, Buxbaum SG, Schreiner PJ, Ellison RC, Tsai MY, Patel SR, Redline S, Johnson AD, Hoogeveen RC, Hakonarson H, Rotter JI, Boerwinkle E, de Bakker PI, Kivimaki M, Asselbergs FW, Sattar N, Lawlor DA, Whittaker J, Davey Smith G, Mukamal K, Psaty BM, Wilson JG, Lange LA, Hamidovic A, Hingorani AD, Nordestgaard BG, Bobak M, Leon DA, Langenberg C, Palmer TM, Reiner AP, Keating BJ, Dudbridge F, Casas JP; InterAct Consortium
  BMJ  2014 Jul 10;349:g4164. doi: 10.1136/bmj.g4164.  Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data
Andri Panayiotou Arking DE, Pulit SL, Crotti L, van der Harst P, Munroe PB, Koopmann TT, Sotoodehnia N, Ros¬sin EJ, Morley M, Wang X, Johnson AD, Lundby A, Gudbjartsson DF, Noseworthy PA, Eij¬gelsheim M, Bradford Y, Tarasov KV, Dörr M, Müller-Nurasyid M, Lahtinen AM, Nolte IM, Smith AV, Bis JC, Isaacs A, Newhouse SJ, Evans DS, Post WS, Waggott D, Lyytikäinen LP, Hicks AA, Eisele L, Ellinghaus D, Hayward C, Navarro P, Ulivi S, Tanaka T, Tester DJ, Chatel S, Gustafsson S, Kumari M, Morris RW, Naluai AT, Padmanabhan S, Kluttig A, Strohmer B, Panayiotou AG, Torres M, Kno¬flach M, Hubacek JA, Slowikowski K, Raychaudhuri S, Kumar RD, Harris TB, Launer LJ, Shuldiner AR, Alonso A, Bader JS, Ehret G, Huang H, Kao WH, Strait JB, Macfarlane PW, Brown M, Caulfield MJ, Samani NJ, Kronenberg F, Willeit J; CARe Consortium; COGENT Consortium, Smith JG, Greiser KH, Meyer Zu Schwabedissen H, Wer-dan K, Carella M, Zelante L, Heckbert SR, Psaty BM, Rotter JI, Kolcic I, Polašek O, Wright AF, Griffin M, Daly MJ; DCCT/EDIC, Arnar DO, Hólm H, Thorsteinsdottir U; eMERGE Consortium, Denny JC, Roden DM, Zuvich RL, Emilsson V, Plump AS, Larson MG, O’Don¬nell CJ, Yin X, Bobbo M, D’Adamo AP, Iorio A, Sinagra G, Carracedo A, Cummings SR, Nalls MA, Jula A, Kontula KK, Marjamaa A, Oikarinen L, Perola M, Porthan K, Erbel R, Hoffmann P, Jöckel KH, Kälsch H, Nöthen MM; HRGEN Consortium, den Hoed M, Loos RJ, Thelle DS, Gieger C, Meitinger T, Perz S, Peters A, Prucha H, Sinner MF, Waldenberger M, de Boer RA, Franke L, van der Vleuten PA, Beckmann BM, Martens E, Bardai A, Hofman N, Wilde AA, Behr ER, Dalageorgou C, Giudices¬si JR, Medeiros-Domingo A, Barc J, Kyndt F, Probst V, Ghidoni A, In-solia R, Hamilton RM, Scherer SW, Brandimarto J, Margulies K, Moravec CE, Greco M FD, Fuchsberger C, O’Connell JR, Lee WK, Watt GC, Campbell H, Wild SH, El Mokhtari NE, Frey N, Asselbergs FW, Mateo Leach I, Navis G, van den Berg MP, van Veldhuisen DJ, Kellis M, Krijthe BP, Franco OH, Hofman A, Kors JA, Uitterlinden AG, Witteman JC, Kedenko L, Lamina C, Oostra BA, Abecasis GR, Lakatta EG, Mulas A, Orrú M, Schlessinger D, Uda M, Markus MR, Völker U, Snieder H, Spector TD, Arnlöv J, Lind L, Sundström J, Syvänen AC, Kivimaki M, Kähönen M, Mononen N, Raitakari OT, Viikari JS, Adamkova V, Kiechl S, Brion M, Nicolaides AN, Paulweber B, Haerting J, Dominiczak AF, Nyberg F, Whincup PH, Hin-gorani AD, Schott JJ, Bezzina CR, Ingelsson E, Ferrucci L, Gasparini P, Wilson JF, Rudan I, Franke A, Mühleisen TW, Pramstaller PP, Lehtimäki TJ, Paterson AD, Parsa A, Liu Y, van Duijn CM, Siscovick DS, Gudnason V, Jamshidi Y, Salomaa V, Felix SB, Sanna S, Ritchie MD, Stricker BH, Stefansson K, Boyer LA, Cappola TP, Olsen JV, Lage K, Schwartz PJ, Kääb S, Chakravarti A, Ackerman MJ, Pfeufer A, de Bakker PI, Newton-Cheh C.    Nat Genet 2014 Aug;46(8):826-36. doi: 10.1038/ng.3014. Epub 2014 Jun 22.  Genetic association study of QT interval highlights role for calcium signaling pathways in myocardi­al repolarization
Andri Panayiotou Kouis P, Pampaka D, Panayiotou AG   EMJ Hepatol 2014 1:62-70 201419  Adipose tissue, metabolic Syndrome and non-alcoholic fatty liver disease-A short review
Andri Panayiotou Voskarides K, Hadjipanagi D, Papazachariou L, Griffin M, Panayiotou AG   Genet Test Mol Biomarkers 2014 Aug;18(8):552-6. doi: 10.1089/gtmb.2014.0020. Epub 2014 Apr 10.  Evidence for contri¬bution of the Y chromosome in atherosclerotic plaque occurrence in men
Andri Panayiotou Owusu Adjah ES, Panayiotou AG   Malar J 2014 Mar 28;13:123. doi: 10.1186/1475- 2875-13-123.  Impact of malaria related messages on insecticide-treated net (ITN) use for malaria prevention in Ghana
Andri Panayiotou Panayiotou AG, Kamilari E, Griffin M, Tyllis T, Georgiou N, Bond D, Hoppensteadt D, Fareed J, Nicolaides A.    Int Angiol 2013 Dec;32(6):599-604 Association between serum levels of pro-metalloproteinase 1, tissue inhibitor of metalloproteinases 1 and 2 and prevalent cardiovascular disease in a population-based study
Andri Panayiotou Panayiotou AG, Griffin MB, Tyllis T, Georgiou N, Bond D, Humphries SE, Nicolaides AN   Vasc Med 2013 Oct;18(5):298-306 Associ¬ation of genotypes at the matrix metalloproteinase (MMP) loci with carotid IMT and presence of carotid and femoral atherosclerotic plaques
Andri Panayiotou Panayiotou AG, Griffin M, Kouis P, Tyllis T, Georgiou N, Bond D, Nicolaides AN.    Diabetol Metab Syndr.  2013 Aug 20;5:44 Association be­tween presence of the metabolic syndrome and its components with carotid intima-media thickness and carotid and femoral plaque area: a population study
Andri Panayiotou Holmes MV, Simon T, Exeter HJ, Folkersen L, Asselbergs FW, Guardiola M, Cooper JA, Palmen J, Hubacek JA, Carruthers KF, Horne BD, Brunisholz KD, Mega JL, van Iperen EP, Li M, Leusink M, Trom¬pet S, Verschuren JJ, Hovingh GK, Dehghan A, Nelson CP, Kotti S, Danchin N, Scholz M, Haase CL, Rothenbacher D, Swerdlow DI, Kuchenbaecker KB, Staines-Urias E, Goel A, van ‘t Hooft F, Gertow K, de Faire U, Panayiotou AG, Tremoli E, Baldassarre D, Veglia F, Holdt LM, Beutner F, Gansevoort RT, Navis GJ, Mateo Leach I, Breitling LP, Brenner H, Thiery J, Dallmeier D, Franco-Cereceda A, Boer JM, Stephens JW, Hofker MH, Tedgui A, Hofman A, Uitterlinden AG, Adamkova V, Pitha J, Onland-Moret NC, Cramer MJ, Nathoe HM, Spiering W, Klungel OH, Kumari M, Whincup PH, Morrow DA, Braund PS, Hall AS, Olsson AG, Doevendans PA, Trip MD, Tobin MD, Hamsten A, Watkins H, Koenig W, Nicolaides AN, Teupser D, Day IN, Carlquist JF, Gaunt TR, Ford I, Sattar N, Tsimikas S, Schwartz GG, Lawlor DA, Morris RW, Sandhu MS, Poledne R, Maitland-van der Zee AH, Khaw KT, Keating BJ, van der Harst P, Price JF, Mehta SR, Yusuf S, Witteman JC, Franco OH, Jukema JW, de Knijff P, Tybjaerg-Hansen A, Rad¬er DJ, Farrall M, Samani NJ, Kivimaki M, Fox KA, Humphries SE, Anderson JL, Boekholdt SM, Palmer TM, Eriksson P, Paré G, Hingorani AD, Sabatine MS, Mallat Z, Casas JP, Talmud PJ.    Am Coll Cardiol 2013 Nov 19;62(21):1966-76 Secretory phospholipase A(2)-IIA and cardiovascular disease: a mendelian randomization study
Andri Panayiotou Griffin M, Nicolaides A, Tyllis T, Georgiou N, Martin RM, Bond D, Panayiotou A, Tziakouri Ch, Dore CJ, Fessas CH   Int Angiol 2010 Jun;29(3):216-25 Plaque area at carotid and common femoral bifurcations and prevalence of clinical cardiovascular disease
Andri Panayiotou Casas JP, Ninio E, Panayiotou A, Palmen J, Cooper JA, Ricketts SL, Sofat R, Nicolaides AN, Corset­ti JP, Fowkes FG, Tzoulaki I, Kumari M, Brunner EJ, Kivimaki M, Marmot MG, Hoffmann MM, Win­kler K, März W, Ye S, Stirnadel HA, Boekholdt SM, Khaw KT, Humphries SE, Sandhu MS, Hingorani, AD, Talmud PJ   Circulation 2010 Jun 1;121(21):2284-93. 20  PLA2G7 genotype, lipoprotein-associated phospholipase A2 activity, and coronary heart disease risk in 10 494 cases and 15 624 controls of European Ancestry
Andri Panayiotou Panayiotou AG, Nicolaides AN, Griffin M, Tyllis T, Georgiou N, Bond D, Martin RM, Hoppen­steadt D, Fareed J, Humphries SE   Atherosclerosis 2010 Jul;211(1):176-81 Leukocyte telomere length is associated with measures of sub­clinical atherosclerosis
Andri Panayiotou Griffin M, Nicolaides A, Tyllis T, Georgiou N, Martin RM, Bond D, Panayiotou A, Tziakouri C, Doré CJ, Fessas C   Vasc Med 2009 Aug;14(3):227-32 Carotid and femoral arterial wall changes and the prevalence of clinical cardio­vascular disease
Andri Panayiotou Panayiotou A, Nicolaides A, Griffin M, Tyllis T, Georgiou N, Martin RM, Bond D, Tziakou­ri-Shiakalli C, Fessas C, Deltas C.    Expert Opin Ther Targets 2009 Jan;13(1):1-11 Serum total homocysteine, folate, 5,10-methylenetetrahydrofolate reductase (MTHFR) 677C>T genotype and subclinical atherosclerosis
Andri Panayiotou Panayiotou A, Griffin M, Georgiou N, Bond D, Tyllis T, Tziakouri-Shiakalli C, Fessas C, Nicolaides A.   Int Angiol 2008 Feb;27(1):74-80 ApoB/ApoA1 ratio and subclinical atherosclerosis

Δημοσιεύσεις

Konstantinos Makris Andrianou XD, Pcharisiadis and KC Makris   Journal Proteome Research 2017 (http://pubs.acs.org/doi/full/10.1021/acs.jproteome.6b01061 Coupling Urinary Trihalomethanes and Metabolomic Profiles of Type II Diabetes: A Case-Control Study
Konstantinos Makris Gaengler S., Andrianou X.D., Piciu A., Charisiadis P., Zira C., Aristidou K., Piciu D., Makris K.C. A study on possible risk factors of thyroid nodules. Romania served as a reference with a comparative thyroid cancer prevalence < EU average. This study aimed to assess the association between urinary iodine (UI) and thyroid nodules in adult females (n = 208) from Cyprus and Romania. A case-control study. Cases were females with ultrasound-confirmed thyroid nodules and controls with confirmed absence of nodules. Subjects underwent ultrasound medical examinations, completed a questionnaire and offered a spot urine sample. Median UI level in Cyprus was 94 μg/L, whereas 32% of the Cypriot UI was < 50 μg/L, classifying the population as mildly iodine deficient. In Romania, both cases and controls were iodine sufficient. No significant differences (P > 0.05) in serum free thyroxin (fT4) and thyroid stimulating hormone (TSH) levels were found between cases and controls. Cases had lower median TSH levels compared with controls (1.4 mIU/L and 1.7 mIU/L, P = 0.060), but serum TSH and free thyroxin levels were within normal range. This was the first study to quantify UI levels in Cyprus. While the Romanian iodine fortification programme reflected onto its UI levels, a representative assessment of iodine status in Cyprus will address the necessity of an iodine fortification programme. Public Health 2017    10.1016/j.puhe.2016.10.027 Iodine status and thyroid nodules in females: a comparison of Cyprus and Romania.
Konstantinos Makris Tsangari X., Andrianou X.D., Agapiou A., Mochalski P., Makris K.C. Benzene, toluene, ethylbenzene, o-, m-, and p-xylenes (BTEX) are ubiquitous outdoor and indoor air pollutants associated with both environmental and health effects. The objective of this exploratory study was to determine the magnitude and variability of urinary BTEX levels among residents of two areas located in the same city (Nicosia, Cyprus). The two areas differed with respect to their proximity to an industrial cluster and an intercity-highway. First morning urine voids were collected in the two urban areas (n = 48). The majority of participants were females (65%) and non-smokers (85%) with a mean age of 49 years. Median urinary BTEX levels were: 118 ng L-1, 124 ng L-1, 9 ng L-1, 29 ng L-1 and 28 ng L-1 for benzene, toluene, ethylbenzene, (p + m)-xylene and o-xylene, respectively. With the exception of benzene, participants from area 2 (closer to the industrial cluster and an intercity road than area 1) had significantly (p < 0.05) higher urinary BTEX levels than those from area 1 (regression analysis). The residence location (in area 2) was the sole significant (p < 0.05) predictor of urinary BTEX levels after adjusting for sex, smoking, age, body mass index, and educational level. Chemosphere 2017 10.1016/j.chemosphere.2017.01.043 spatial characteristics of urinary BTEX concentrations in the general population
Konstantinos Makris Andrianou X.D., Gängler S, Piciu A., Charisiadis P., Zira C., Aristidou K., Piciu D., Hauser R., Makris K.C. Environmental factors, such as exposures to thyroid-disrupting chemicals may contribute to thyroid nodular disease (TND) and altered thyroid function. We investigated the association between exposures to bisphenol A (BPA), its chlorinated derivatives (ClxBPA), and bisphenol F (BPF) with TND and thyroid measures in adult women. A case-control study in Cyprus and Romania (n = 212) was conducted, where cases were those with thyroid nodules (diameter >3mm), and controls without nodules. Serum TSH and free thyroxine and urinary levels of BPA, BPF and ClxBPA were measured using immunoassays and tandem mass spectrometry, respectively. The association between exposures to BPA compounds and TND, adjusting for age, BMI, thyroid hormones and urinary iodine was assessed using logistic regression. Linear regression was used to explore associations between urinary BPA, BPF and ClxBPA and serum thyroid hormones. With the exception of a chlorinated BPA compound (30%), the rest of bisphenols were quantified in 100% of urine samples. A positive and significant (p<0.05) association was observed between urinary BPA and serum TSH that remained after adjusting for urinary creatinine, age, BMI, study site and disease status. Our study found associations of urinary BPA with TSH but not with BPF or ClxBPA. PLoS One 2016 10.1371/journal.pone.0155237 Human exposores to bisphenol A, bisphenol F and chlorinated bisphenol A Deratives and Thyroid Function
Konstantinos Makris Makris K.C., Andrianou X.D., Charisiadis P., Burch J.B., Seth R.K., Ioannou A., Picolos M., Christophi C.A., Chatterjee S. Non-alcoholic fatty liver disease (NAFLD) is commonly diagnosed in the majority of obese patients with type 2 diabetes mellitus (T2DM). The objectives of this study were to: i) determine the association of urinary brominated THM (BrTHM) levels and T2DM disease status, and ii) investigate the association between urinary BrTHM levels and serum alanine aminotransferase (ALT) concentrations, often used as surrogate markers of NAFLD. A pilot case-control study was conducted in Nicosia, Cyprus (n=95). Cases were physician-diagnosed T2DM patients and controls were healthy individuals. Liver enzymes, leptin and TNF-α were measured in sera, while urinary THM levels were measured using tandem mass spectrometry. Among all study participants those with serum ALT levels above the median (17IU/L) had higher mean tribromomethane (TBM) concentrations compared to those with serum ALT below 17IU/L. A significant increase in the odds of having above the median serum ALT levels was observed for each unit increase in creatinine-unadjusted urinary TBM levels, along with BMI and past smoking, after adjusting for possible confounders, such as urinary creatinine, age, sex, and leptin; no other THM compound showed a significant association with serum ALT. The interplay between exposures to BrTHM and the initiation of key pathophysiological events relating to hepatic injury (ALT) and inflammation (leptin) was recognized via the use of selected biomarkers of effect. Environment International 2016 10.1016/j.envint.2016.04.012 association between exposures to brominated trihalomethanes hepatic injury and type 2 diabetes mellitus
Konstantinos Makris Piciu A., Andrianou X.D., Irimie A., Bălăcescu O., Zira C., BĂRBUş E., Peştean C., Aristeidou K., Theofanous T., Agathokleous M., Piciu D., Makris K.C. A pilot case-control study has been conducted in 2014-2015 in Romania and Cyprus. Cases were women with ultrasound-confirmed thyroid nodules of size >3mm. Controls were women without thyroid nodules after ultrasound confirmation. All participants provided blood samples for measurements of the thyroid stimulating hormone (TSH), free thyroxin (FT4), anti-thyroglobulin (ATg) and anti-thyroid peroxidase (ATPO); urine samples. Demographics, anthropometrics and other relevant information were provided through the administration of a questionnaire. In Romania we selected 51 patients with thyroid nodules (case group) and 41 without thyroid nodules (control group) and in Cyprus 57 cases, respectively 65 controls. After the statistical analysis of the data collected we observed statistically significant differences between the populations of the two countries regarding BMI and the value of the thyroid hormones and antibodies. Using the data observed in this study, differences were found between Cyprus and Romania among females with thyroid nodules the BMI, and the level of thyroid hormones had statistically significant differences. This study reports preliminary data, further analysis of environmental exposures to chemical factors that might have a certain influence over the thyroid in the two countries will follow. Clujul Mecial 2015 10.15386/cjmed-518. Investigation of thyroid nodules in the female popualtion in Cyprus and Romania
Konstantinos Makris Ioannou P., Charisiadis P., Andra S.S., Makris K.C. Non-iodo-containing trihalomethanes (TTHM) are frequently detected in chlorinated tap water and currently regulated against their carcinogenic potential. The main objective of this study was to determine the magnitude and variability of ITHM and TTHM levels and their corresponding daily intake estimates within the drinking water distribution systems of Limassol and Nicosia cities of Cyprus, using tap samples collected from individual households (n=37). In Limassol, mean household tap water ITHM and TTHM levels was 0.58 and 38 μg L(-1), respectively. Dichloroiodomethane (DCIM) was the dominant species of the two measured ITHM compounds accounting for 77% of total ITHM and in the range of 0.032 and 1.65 μg L(-1). The range of DCIM concentrations in Nicosia tap water samples was narrower (0.032 - 0.848 μg L(-1)). Mean total iodine concentration in tap water samples from the seaside city of Limassol was 15 μg L(-1) and approximately twice to those observed in samples from the mainland Nicosia city. However, iodine concentrations did not correlate with the ITHM levels. The calculated chronic daily intake rates of ITHM were low when compared with those of TTHM, but because of their widespread occurrence in tap water and their enhanced mammalian cell toxicity, additional research is warranted to assess the magnitude and variability of human ITHM exposures. The Science of the Total Environment 2016 10.1016/j.scitotenv.2015.10.031. Occurence and variability of iodinated trihalomethanes concentrations within two drinking-water distribution networks
Konstantinos Makris Botsaris G., Kanetis L., Slaný M., Parpouna C., Makris K.C. Microorganisms can survive and multiply in aged urban drinking water distribution systems, leading to potential health risks. The objective of this work was to investigate the microbial quality of tap water and molecularly identify its predominant cultivable microorganisms. Tap water samples collected from 24 different households scattered in the urban area of Limassol, Cyprus, were microbiologically tested following standard protocols for coliforms, E. coli, Pseudomonas spp., Enterococcus spp., and total viable count at 22 and 37 °C. Molecular identification was performed on isolated predominant single colonies using 16SrRNA sequencing. Approximately 85% of the household water samples were contaminated with one or more microorganisms belonging to the genera of Pseudomonas, Corynebacterium, Agrobacterium, Staphylococcus, Bacillus, Delftia, Acinetobacter, Enterococcus, Enterobacter, and Aeromonas. However, all samples tested were free from E. coli. This is the first report in Cyprus molecularly confirming specific genera of relevant microbial communities in tap water. Environmental monitoring and assessment 2015 10.1007/s10661-015-4957-9. Microbial quality and molecular identification of cultivable microorganisms isolated from an urban drinking water distribution system (Limassol, Cyprus)
Konstantinos Makris Andra S.S., Charisiadis P., Arora M., van Vliet-Ostaptchouk J.V., Makris K.C. The high reactivity of bisphenol A (BPA) with disinfectant chlorine is evident in the instantaneous formation of chlorinated BPA derivatives (ClxBPA) in various environmental media that show increased estrogen-activity when compared with that of BPA. The documented health risks associated with BPA exposures have led to the gradual market entry of BPA structural analogs. A suite of exposure sources to ClxBPA and BPA analogs in the domestic environment is anticipated to drive the nature and range of halogenated BPA derivatives that can form when residual BPA comes in contact with disinfectant in tap water and/or consumer products. The primary objective of this review was to survey all available studies reporting biomonitoring protocols of ClxBPA and structural BPA analogs (BPS, BPF, BPB, etc.) in human matrices. During the last decade, an increasing number of ecotoxicological, cell-culture and animal-based and human studies dealing with ClxBPA exposure sources and routes of exposure, metabolism and toxicity have been published. Up to date findings indicated the association of ClxBPA with metabolic conditions, such as obesity, lipid accumulation, and type 2 diabetes mellitus, particularly in in-vitro and in-vivo studies.  Environment International 2015 10.1016/j.envint.2015.09.011 Biomonitoring of human epxosures to chlorinated derivates and structural analogs of bisphenol A. 
Konstantinos Makris Andra S.S., Makris K.C. The objective of this exploratory post hoc analysis of our cross-sectional study's dataset was to evaluate the association between urinary levels of BPA and monochlorinated BPA (mono-ClBPA) with body mass index (BMI) in a random sample of 223 adults (≥18 years) from the general population in Cyprus.. We observed a relatively weak positive association between urinary mono-ClBPA and BMI, such as (i) 76 ng g(-1) in participants with above normal BMI (≥25 kg m(-2)) versus 55 ng g(-1) in those with normal BMI (<25 kg m(-2)) (P for mean difference = 0.053) and (ii) higher percentage of participants with above normal BMI in the high urinary mono-ClBPA tertile (63% in tertile 3 and 57% in tertile 2 versus 50% in tertile 1, P for trend = 0.056). A dichotomously-classified group analysis showed an increased odds ratio (OR) for higher BMI in the group with high creatinine-adjusted urinary levels of BPA and mono-ClBPA when compared with the participants group with low levels for both compounds [logistic model adjusted for gender and health status as potential confounders; adjusted OR (95% CI): 2.34 (1.10, 5.10), P = 0.027]. Measurements of both BPA and its trace chlorinated derivative in human matrices may be warranted for a comprehensive exposure assessment towards improving our understanding of their obesogenic effects. Journal of environmental science and health. Part A, Toxic/hazardous substances & environmental engineering 2015 10.1080/10934529.2015.1047674 Association betwee urinary levels of bisphenol A and it monochlorinated derivative and obesity 
Konstantinos Makris Papadakis E.N., Vryzas Z., Kotopoulou A., Kintzikoglou K., Makris K.C., Papadopoulou-Mourkidou E. A pesticide monitoring study covering the main rivers and lakes of Northern Greece (Macedonia, Thrace and Thessaly) was undertaken. A total of 416 samples were collected over a 1.5-year sampling period (September 1999- February 2001) from six rivers and ten lakes. The water samples were analyzed using an analytical method for 147 pesticides and their metabolites. Based on the pesticide survey results, a human health carcinogenic and non-carcinogenic risk assessment was conducted for adults and children.. Results showed that the herbicides metolachlor, prometryn, alachlor and molinate, were the most frequently detected pesticides (29%, 12.5%, 12.5% and 10%, respectively). They also exhibited the highest concentration values, often exceeding 1 μg/L. Chlorpyrifos ethyl was the most frequently detected insecticide (7%).. The highest concentrations were recorded during May-June period, right after pesticide application. Concentrations of six pesticides were above the maximum allowable limit of 0.1 μg/L set for drinking water. Alachlor, atrazine and a-HCH showed unacceptable carcinogenic risk estimates (4.5E-06, 4.6E-06 and 1.3E-04, respectively). Annual average concentrations of chlorpyriphos ethyl (0.031 μg L), dicofol (0.01 μg/L), dieldrin (0.02 μg/L) and endosulfan a (0.065 μg/L) exceeded the EU environmental quality standards. The risk quotient estimates for the insecticides chorpyrifos ethyl, diazinon and parathion methyl and herbicide prometryn were above acceptable risk values.  Ecotoxicology and environmental safety 2015 10.1016/j.ecoenv.2015.02.033 A pesticide monitoring survey in rivers and lakes of northern Greece and its human and ecotoxicological risk assessment
Konstantinos Makris Andra S.S., Kalyvas H., Andrianou X.D., Charisiadis P., Christophi C.A., Makris K.C. We evaluated the association between urinary monochlorinated BPA (mono-ClBPA) concentrations and the incidence of T2DM. In our cross-sectional study, we identified 20 adult participants (≥18 yr) who reported having T2DM (doctor-diagnosed) and 131 adults with normal health. First morning void urine samples were analyzed for total BPA and mono-ClBPA. Detection limits of the analytical method were 95 ng L(-1) for BPA and 32 ng L(-1) for mono-ClBPA. Multivariable logistic regression analyses and additive Bayesian network modeling were performed. After adjusting for age, gender, BMI, urinary total BPA and other confounders, the odds of having T2DM was 3.29 times higher (95% confidence interval, CI: 1.10, 11.4; P < 0.05) per unit increase in log-transformed and creatinine-adjusted urinary mono-ClBPA levels (n = 151); this relation did not hold for total BPA. The globally optimum Bayesian model corroborated the results of the logistic regression by expressing mono-ClBPA in the pathway of T2DM, and not for total BPA. An age-matched sensitivity analysis confirmed the increase in OR of T2DM by 3.04 times (95% CI: 1.10, 11.0; P < 0.05) per unit increase in log-transformed and creatinine-adjusted urinary mono-ClBPA concentration (n = 68). The urinary monochlorinated BPA derivative was significantly associated with T2DM, whereas the parent compound (total BPA) was not.  Journal of environmental science and health. Part A, Toxic/hazardous substances & environmental engineering 2015 10.1080/10934529.2015.981111 Preliminary evidence of the association between monochlorinated bisphenol A exposure and type 2 diabetes mellitus: a pilot study
Konstantinos Makris Andrianou X.D., Charisiadis P., Andra S.S., Makris K.C. A complex network of sources and routes of exposure to disinfection by-products (DBP), such as trihalomethanes (THM) has been driving the wide variability of daily THM intake estimates in environmental epidemiological studies. We hypothesized that the spatiotemporal variability of THM exposures could be differentially expressed with their urinary levels among residents whose households are geographically clustered in district-metered areas (DMA) receiving the same tap water. Each DMA holds unique drinking-water pipe network characteristics, such as pipe length, number of pipe leaking incidences, number of water meters by district, average minimum night flow and average daily demand. The present study assessed the spatial and seasonal variability in urinary THM levels among residents (n=310) of geocoded households belonging to two urban DMA of Nicosia, Cyprus, with contrasting water network properties. First morning urine voids were collected once in summer and then in winter. Results showed that the mean sum of the four urinary THM analytes (TTHM) was significantly higher during summer for residents of both areas. Linear mixed effects models adjusted for age, season and gender, illustrated spatially-resolved differences in creatinine-adjusted urinary chloroform and TTHM levels between the two studied areas, corroborated by differences observed in their pipe network characteristics.  Environmental research 2014 10.1016/j.envres.2014.09.015 Spatial and seasonal variability of urinary trihalimethanes concentrations in urban settings
Konstantinos Makris Charisiadis P., Andra S.S., Makris K.C., Christophi C.A., Skarlatos D., Vamvakousis V., Kargaki S., Stephanou G.E. The objectives were to: (i) characterize the distribution of water trihalomethanes (THM). concentrations in households from two district-metered areas (DMAs) with contrasting UDWDS characteristics sampled in two seasons (summer and winter), and (ii) assess the within- and between-household, spatial variability of water THM accounting for urban drinking-water distribution systems (UDWDS characteristics (household distance from chlorination tank and service pipe leaking incidences). A total of 383 tap water samples were collected from 193 households located in two DMAs within the UDWDS of Nicosia city, Cyprus, and analyzed for the four THM species. The higher intraclass correlation coefficient (ICC) values for water tribromomethane (TBM) (0.75) followed by trichloromethane (0.42) suggested that the two DMAs differed with respect to these analytes. On the other hand, the low ICC values for total THM levels between the two DMAs suggested a large variance between households. The effect of households nested under each DMA remained significant (p<0.05) for TBM (not for the rest of the THM species) in the multivariate mixed-effect models, even after inclusion of pipe network characteristics. Our results could find use by water utilities in overcoming techno-economic difficulties associated with the large spatiotemporal variability of THM, while accounting for the influence of UDWDS features at points of water use. The Science of the Total Environment 2015 10.1016/j.scitotenv.2014.10.071 Spatial and seasonal variability of tap water disinfection by-products within distribution pipe networks
Konstantinos Makris Andra S.S., Charisiadis P., Karakitsios S., Sarigiannis D.A., Makris K.C. Domestic cleaning has been proposed as a determinant of trihalomethanes (THMs) exposure in adult females. g. In a recent cross-sectional study (n = 382) in Cyprus [41 children (< 18 y) and 341 adults (≥ 18 y)], we identified 29 children who met the study's inclusion criteria. Linear regression models were applied to understand the association between children sociodemographic variables, their individual practices influencing ingestion and noningestion exposures to ΣTHMs, and their urinary THMs levels. Among the children-specific variables, age alone showed a statistically significant inverse association with their creatinine-adjusted urinary ΣTHMs (rS = -0.59, p < 0.001). A positive correlation was observed between urinary ΣTHMs (ng g(-1)) of children and matched-mothers (rS = 0.52, p = 0.014), but this was not the case for their matched-fathers (rS = 0.39, p = 0.112). Time spent daily by the matched-mothers for domestic mopping, toilet and other cleaning activities using chlorine-based cleaning products was associated with their children's urinary THMs levels (rS = 0.56, p = 0.007). Our findings highlighted the influence of mothers' domestic cleaning activities towards enhancing passive THMs exposures of their children. The duration of such activities could be further tested as a valid indicator of children's THMs body burden. Environmental research 2015 10.1016/j.envres.2014.10.018 Passive exposures of children to volatile trihalomethanes during domestic cleaning activities of their parents
Konstantinos Makris Andra S.S., Makris K.C., Charisiadis P., Costa C.N. Potable water samples (N = 74) from 19 zip code locations in a region of Greece were profiled for 13 trace elements composition using inductively coupled plasma mass spectrometry. The primary objective was to monitor the drinking water quality, while the primary focus was to find novel associations in trace elements occurrence that may further shed light on common links in their occurrence and fate in the pipe scales and corrosion products observed in urban drinking water distribution systems. Except for arsenic at two locations and in six samples, rest of the analyzed elements was below maximum contaminant levels. Further, we attempted to hierarchically cluster trace elements based on their covariances resulting in two groups; one with arsenic, antimony, zinc, cadmium, and copper and the second with the rest of the elements. The grouping trends were partially explained by elements' similar chemical activities in water, underscoring their potential for co-accumulation and co-mobilization phenomena from pipe scales into finished water. Profiling patterns of trace elements in finished water could be indicative of their load on pipe scales and corrosion products, with a corresponding risk of episodic contaminant release. Speculation was made on the role of disinfectants and disinfection byproducts in mobilizing chemically similar trace elements of human health interest from pipe scales to tap water.  Environmental monitoring and assessment 2014 10.1007/s10661-014-3928-x Co-occurence profiles of trace elements in potable water systems: a case study
Konstantinos Makris Kalyvas H., Andra S.S., Charisiadis P., Karaolis C., Makris K.C. Low-dose health effects of BPA in the presence of BPA metabolites of chlorinated structure that may exert larger estrogenic effects than those of their parent compound. Our objective was to investigate the influence of typical household cleaning activities (dishwashing, toilet cleaning, mopping, laundry, etc.) on the magnitude and variability of urinary total BPA and mono-ClBPA levels in the general adult population. A cross-sectional study (n=224) included an adult (≥18 years) pool of participants from the general population of Nicosia, Cyprus. First morning urine voids were collected, and administered questionnaires included items about household cleaning habits, demographics, drinking water consumption rates and water source/usage patterns. Urinary concentrations of total BPA (range: 0.2-82 μg L(-1)), mono-ClBPA (16-340 ng L(-1)), and total trihalomethanes (0.1-5.0 μg L(-1)) were measured using gas chromatography coupled with triple quadrupole mass spectrometry and large volume injection. Linear multiple regression analysis revealed that dishwashing along with age and gender (females) were able to predict urinary mono-ClBPA levels (ng g(-1)), even after adjusting for covariates; this was not the case for urinary total BPA levels (ng g(-1)). Significant (p<0.001) association was observed between urinary mono-ClBPA and THM levels, underlying the important role of disinfectant (chlorine) in promoting formation of both ClBPA and THM.  The Science of the Total Environment 2014 10.1016/j.scitotenv.2014.04.072 Influence of household cleaning practices on the magnitude and variability of urinary monochlorinated bisphenol A.
Konstantinos Makris Andra S.S., Charisiadis P., Makris K.C. THM are formed within disinfected tap water and their health effects, under research, range from cancer to adverse reproductive outcomes. The objective of this exploratory analysis was to address obesity-mediated associations between urinary concentrations of brominated THM and incidences of T2DM in a Cypriot adult population (n=326). First morning urine voids were collected once during summer and another time during winter while a detailed questionnaire was administered to participants. Creatinine-adjusted urinary Br-THM analyte concentrations were significantly (p<0.05) higher in T2DM cases when compared with those in healthy individuals. Multivariate logistic regression models adjusted for potential confounders showed that participants with ≥30 kg m(-2) BMI were at a higher T2DM risk (OR=8.42, 95% CI: 1.97, 45.5; p<0.01) when compared with that of normal weight participants (<25 kg m(-2)). About 4 times higher risk for developing T2DM was observed for individuals in the upper tertile of urinary Br-THM levels (OR=3.99, 95% CI: 1.07, 19.7; p<0.05) when compared with the lower tertile participants. Among the participants with BMI≥25 kg m(-2), urinary Br-THM levels were significantly (p<0.001) higher in diabetics than in healthy individuals. Ingestion and non-ingestion exposures to Br-THM deserve careful consideration in relevant epidemiological studies, as a possible environmental risk factor of T2DM. The Science of the Total Environment 2014 10.1016/j.scitotenv.2014.03.075 Obesity-mediated assocation between exposure to brominated trihalomethanes and type 2 diabetes mellitus: an exploratory analysis
Konstantinos Makris Andra S.S., Makris K.C. Human biomonitoring studies for water contaminants are often accompanied by surveys relying solely on total drinking water consumption rates, thus, failing to account for specific water sources (bottled and tap water) and use habits, such as water used for preparing cold/hot beverages (coffee, tea, juice, etc.). Despite the extensive use of bisphenol A (BPA) in polycarbonate (PC)-based water contact materials, rarely do BPA biomonitoring studies focus on various PC water uses and sources. Better resolved water consumption rates could reduce the uncertainty associated with surrogate daily BPA intake estimates using fine-tuned surveys. This approach provided a proof of concept on inclusion of water consumption from various sources and uses into estimates of daily intake for water contaminants like BPA found in water-contact materials.  Journal of water and health 2014 10.2166/wh.2013.068. Incorporating potable water sources and use habits into surveys that improve surrogate exposure for water contaminants: the case of bisphenol A. 
Konstantinos Makris Charisiadis P., Makris K.C. Because of the plethora of exposure sources and routes through which humans are exposed to trihalomethanes (THM), the limitation of their short half-lives could be overcome, if a highly sensitive method was available to quantify urinary THM concentrations at sub-ppb levels. The objective of this study was to develop a fast and reliable method for the determination of the four THM analytes in human urine. A sensitive methodology was developed for THM in urine samples using gas chromatography coupled with triple quadrupole mass spectrometry (GC-QqQ-MS/MS) promoting its use in epidemiological and biomonitoring studies. The proposed methodology enjoys limits of detection similar to those reported in the literature (11-80 ng L(-1)) and the advantages of small initial urine volumes (15 mL) and fast analysis per sample (12 min) when compared with other methods. This is the first report using GC-QqQ-MS/MS for the determination of THM in urine samples. Because of its simplicity and less time-consuming nature, the proposed method could be incorporated into detailed (hundreds of participants' urine samples) exposure assessment protocols providing valuable insight into the dose-response relationship of THM and cancer or pregnancy anomalies Journal of chromatography. B, Analytical technologies in the biomedical and life sciences 2014 10.1016/j.jchromb.2013.11.060 A sensitive and fast method for trihalomethanes in urine using gas chromatography-tripe quadrupole mass spectrometry
Konstantinos Makris Andra S.S., Makris K.C., Botsaris G., Charisiadis P., Kalyvas H., Costa C.N. Changes in disinfectant type could trigger a cascade of reactions releasing pipe-anchored metals/metalloids into finished water. However, the effect of pre-formed disinfection by-products on the release of sorbed contaminants (arsenic-As in particular) from drinking water distribution system pipe scales remains unexplored. A bench-scale study using a factorial experimental design was performed to evaluate the independent and interaction effects of trihalomethanes (TTHM) and haloacetic acids (HAA) on arsenic (As) release from either scales-only or scale-biofilm conglomerates (SBC) both anchored on asbestos/cement pipe coupons. A model biofilm (Pseudomonas aeruginosa) was allowed to grow on select pipe coupons prior experimentation. Either TTHM or HAA individual dosing did not promote As release from either scales only or SBC, detecting <6 μg AsL(-1) in finished water. In the case of scales-only coupons, the combination of the highest spike level of TTHM and HAA significantly (p<0.001) increased dissolved and total As concentrations to levels up to 16 and 95 μg L(-1), respectively. Similar treatments in the presence of biofilm (SBC) resulted in significant (p<0.001) increase in dissolved and total recoverable As up to 20 and 47 μg L(-1), respectively, exceeding the regulatory As limit.  The Science of the Total Environment 2014 10.1016/j.scitotenv.2013.11.045 Evidence of arsenic release promoted by disinfection by-products within drinking-water distrinbution systems
Konstantinos Makris Charisiadis P., Andra S.S., Makris K.C., Christodoulou M., Christophi C.A., Kargaki S., Stephanou E.G. We examined the relation between household cleaning activities (washing dishes/clothes, mopping, toilet cleaning, and washing windows/surfaces) and urinary THM concentrations accounting for water sources, uses, and demographics. A cross-sectional study (n = 326) was conducted during the summer in Nicosia, Cyprus, linking household addresses to the geocoded public water pipe network, individual household tap water, and urinary THM measurements. Household tap water THM concentrations ranged between 3-129 μg L(-1), while the median (Q1, Q3) creatinine-adjusted urinary THM concentration in females (669 ng g(-1) (353, 1377)) was significantly (p < 0.001) higher than that in males (399 ng g(-1), (256, 681)). Exposure assessment, based on THM exposure equivalency units, showed that hand dishwashing, mopping, and toilet cleaning significantly (p < 0.001) increased urinary THM levels. The effect of dishwashing by females ≥36 y of age remained significant, even after adjusting for potential confounders. No significant (p > 0.05) association was observed between ingestion-based THM exposure equivalency units and urinary THM. Noningestion routes of THM exposures during performance of routine household cleaning activities were shown for the first time to exert a major influence on urinary THM levels. It is warranted that future pregnancy-birth cohorts include monitoring of noningestion household THM exposures in their study design. Environmental science & technology 2014 10.1021/es404220z Households cleaning activities as noningestion exposure determinants of urinary trihalomethanes
Konstantinos Makris Makris K.C., Andra S.S. The objectives of this scientific commentary were to (i) highlight the extent of appraisal of water contamination in exposure assessment studies of in pregnancy-birth cohorts (PBC), worldwide, and (ii) propose recommendations to increase awareness of emerging water-related risks through their improved representation into PBC study designs in urban centers. Three scientific literature databases (Scopus, PubMed, and Web of Science) were used for a systematic search on worldwide PBC and their publications that considered water contamination and health outcomes. Publicly-available e-databases (ENRIECO, BIRTHCOHORTS, and CHICOS) were also employed for detailed exploration of existing European Union (EU)-based PBC. Out of the 76 PBC identified in the EU territory, only 12 of them incorporated water contamination into their study designs. Among which only 6 PBC published scientific articles that either included data on water contamination and/or water intake estimates. Trihalomethanes but not other disinfection by-products were mostly studied in the PBC around the globe, while fluoride, atrazine, perfluorinated compounds, tetrachloroethylene, and lead were studied to a lesser extent as water contaminants. It appears that chemical-based water contamination and corresponding human exposures represent a largely underappreciated niche of exposure science pertaining to pregnant mother and children's health in PBC. The Science of the Total Environment 2014 10.1016/j.scitotenv.2013.08.012 Limited representation of drinking-water contaminents in pregancy-birth cohorts
Konstantinos Makris Das P., Sarkar D., Makris K.C., Punamiya P., Datta R. One of the major challenges in developing an effective phytoremediation technology for 2,4,6-trinitrotoluene (TNT) contaminated soils is limited plant uptake resulting from low solubility of TNT. Our preliminary greenhouse experiments using urea were also very promising, but further characterization of the performance of urea in highly-complex soil-solution was necessary. The present study investigated the natural retention capacity of four chemically variant soils and optimized the factors influencing the effectiveness of urea in enhancing TNT solubility in the soil solutions. Results show that the extent of TNT sorption and desorption varies with the soil properties, and is mainly dependent on soil organic matter (SOM) content. Hysteretic desorption of TNT in all tested soils suggests irreversible sorption of TNT and indicates the need of using an extractant to increase the release of TNT in soil solutions. Urea significantly (p<0.0001) enhanced TNT extraction from all soils, by increasing its solubility at the solid/liquid interface. Soil organic matter content and urea application rates showed significant effects, whereas pH did not exert any significant effect on urea catalysis of TNT extraction from soil. The optimum urea application rates (125 or 350 mg kg(-1)) for maximizing TNT extraction were within the limits set by the agronomic fertilizer-N rates used for major agricultural crops.  Chemosphere 2013 10.1016/j.chemosphere.2013.06.028 Effectiveness of urea in enhancing the extractability of 2,4,6-trinitrotoluene from chemically variant soils
Konstantinos Makris Makris K.C., Andra S.S., Jia A., Herrick L., Christophi C.A., Snyder S.A., Hauser R. Little attention has been paid to bisphenol A (BPA) intake from packaged water consumption (PC water dispensers), especially during summer weather conditions. We determined the magnitude and variability of urinary BPA concentrations during summer in 35 healthy individuals largely relying upon PC packaged water to satisfy their potable needs. We used liquid chromatography-tandem mass spectrometry to measure urinary BPA concentrations. A questionnaire was administered in July/August and a spot urine sample was collected on the same day and 7 days after the completion of the interview (without intervention). Linear regression was performed to assess the association of variables, such as water consumption from different sources, on urinary BPA levels for the average of the two urine samples. A significant positive association (p = 0.017) was observed between PC water consumption and urinary BPA levels in females, even after adjusting for covariates in a multivariate regression model. The geometric mean of daily BPA intake back-calculated from urinary BPA data was 118 ng · (kg bw)(-1) · day(-1), nearly double the average intake levels observed in biomonitoring studies worldwide. High urinary BPA levels were partially ascribed to summer's high PC water consumption and weather characteristics (high temperatures, >40 °C; very high UV index values, >8), which could be causing BPA leaching from PC Environmental science & technology 2013 10.1021/es304038k Association between water consumption from polycarbonate containers and bisphenol A intake during harsh environmental conditions in summer
Konstantinos Makris Makris K.C., Andra S.S., Herrick L., Christophi C.A., Snyder S.A., Hauser R. This study set out to investigate the relationship between drinking-water source, use characteristics, and urinary Sb concentrations (U-Sb) accompanied with survey responses of a healthy (n=35) Cypriot participant pool. One spot urine sample was collected during administration of questionnaire, while a second spot urine sample was collected from the same individual about 7 days later. Urinary and water Sb concentrations were measured with an inductively coupled plasma mass spectrometer. Survey responses showed that bottled water summed over various volumes and plastic types, such as polycarbonate and PET contributed to an average 61% of daily water consumption. Water sources such as tap, mobile stations (explained in a following section), and well water contributed to 24%, 14%, and 2% of an individual's daily water consumption pattern, respectively. Average daily potable water use of both bottled and tap water by individuals consisted of 65% drinking-water, while the remaining 35% was water used for preparing cold and hot beverages, such as, tea, coffee, and juices. A significant (P=0.02) association between per capita water consumption from PET bottles and urinary creatinine-unadjusted concentrations was observed, but this relationship did not remain after inclusion of covariates in a multivariate regression model. In the creatinine-adjusted regression model, only gender (female) was a significant (P<0.01) predictor of U-Sb, after adjusting for several covariates.. Journal of exposure sciecnce & environmental epidemiology 2013 10.1038/jes.2012.104 Association of drinking-water source and use characteristics with urinary antimony concentrations
Konstantinos Makris Andra S.S., Makris K.C., Christophi C.A., Ettinger A.S. on-carcinogenic effects in low-level (< 100 μgL(-1)) arsenic (As)-impacted populations, such as the development and progression of type-2 diabetes mellitus (T2DM), are often neglected given the primary emphasis of public health authorities on As carcinogenicity. We gathered studies reporting urinary biomarkers of As exposure (U-As) and biomarkers associated with T2DM and its complications (U-T2DM), such as renal damage, oxidation stress, low-grade inflammation, and endothelial damage. Studied U-T2DM biomarkers were: 8-hydroxy-2'deoxyguanosine, N-acetyl-β-d-glucosaminidase, β2-microglobulin, and albumin. Data was expressed as: either arithmetic means and standard deviations, or geometric means and geometric standard deviations, or correlation coefficients of U-As and U-T2DM. Urinary As concentrations were consistently associated with the aforementioned biomarkers of T2DM pathologic complications. Despite the limited selectivity of the selected T2DM biomarkers, a per unit change in As exposure level was reflected in the corresponding T2DM biomarker urinary concentrations. Our systematic review provides new evidence on the role of environmental As exposures influencing the T2DM disease process. Additional epidemiologic studies onto the association between As and T2DM should incorporate both urinary As and T2DM biomarkers, as suggested in this study, in order to evaluate subclinical effects of low-level As exposures. International journal of hygiene and environmental health 2013 10.1016/j.ijheh.2012.07.001 Delineating the degree of association between biomarkers of arsenic exposure and type-2 diabetes mellitus
Konstantinos Makris Andra S.S., Makris K.C. The globally escalating thyroid nodule incidence rates may be only partially ascribed to better diagnostics, allowing for the assessment of environmental risk factors on thyroid disease. Endocrine disruptors or thyroid-disrupting chemicals (TDC) like bisphenol A, phthalates, and polybrominated diphenyl ethers are widely used as plastic additives in consumer products. This comprehensive review studied the magnitude and uncertainty of TDC exposures and their effects on thyroid hormones for sensitive subpopulation groups like pregnant women, infants, and children. Our findings qualitatively suggest the mixed, significant (α = 0.05) TDC associations with natural thyroid hormones (positive or negative sign). Future studies should undertake systematic meta-analyses to elucidate pooled TDC effect estimates on thyroid health indicators and outcomes. Journal of environmental science and health. Part C, Environmental carcinogenesis & ecotoxicology reviews 2012 10.1080/10590501.2012.681487 Thyroid disrupting chemicals in plastic additives and thyroid health
Konstantinos Makris Makris K.C., Christophi C.A., Paisi M., Ettinger A.S. A preliminary study was undertaken in a community of Cyprus where low-level arsenic (As) concentrations were recently detected in the groundwater that was chronically used to satisfy potable needs of the community. The main objective of the study was to assess the degree of association between orally-ingested As and self-reported type-2 diabetes mellitus (DM) in 317 adult (≥18 years old) volunteers. Cumulative lifetime As exposure (CLAEX) (mg As) was calculated using the median As concentrations in water, individual reported daily water consumption rates, and lifetime exposure duration. Logistic regression models were used to model the probability of self-reported DM and calculate odds ratios (OR) in univariate and multivariate models. Significantly higher (p < 0.02) CLAEX values were reported for the diabetics (median = 999 mg As) versus non-diabetics (median = 573 mg As), suggesting that As exposure could perhaps be related to the prevalence of DM in the study area, which was 6.6%. The OR for DM, comparing participants in the 80th versus the 20th percentiles of low-level As CLAEX index values, was 5.0 (1.03, 24.17), but after adjusting for age, sex, smoking, education, and fish consumption, the As exposure effect on DM was not significant. BMC public health 2012 10.1186/1471-2458-12-334 A preliminary assessment of low level arsenic exposure and diabetes mellitus in Cyprus
Konstantinos Makris Economides C., Liapi M., Makris K.C. In addition to diet-based vectors of disease, the contribution of water-borne zoonotic agents to gastrointestinal illnesses may be significant, but this has yet to be investigated for Cyprus. Our main objective was to evaluate antibiotic resistance patterns of Salmonella and Escherichia coli in groundwater samples collected at confined animal feeding operations. This is the first report on the occurrence of antibiotic-resistant Salmonella and E. coli strains in the groundwater of Cyprus. Most of Salmonella isolates belonged to the subgroup enterica, whereas none of the E. coli isolates expressed the verotoxin-encoding gene. Out of 27 isolated Salmonella strains, nearly half of them were resistant to at least one or more antibiotic, whereas the highest resistance was exhibited by sulphamethoxazole (85%), followed by streptomycin (39%), and tetracycline (31%). For the E. coli isolates, nearly a third of them showed resistance to at least one antibiotic, whereas the selection of antibiotic resistance was equal among sulphamethoxazole, tetracycline and streptomycin (20%). This study demonstrated that Salmonella and E. coli in groundwater could pose a public health risk via oral ingestion of contaminated water. Environmental geochemistry and health 2012 10.1007/s10653-012-9450-6 Antibiotic resistance patterns of Salmonella and Escherichia coli in the groundwater of Cyprus
Konstantinos Makris Andra S.S., Makris K.C., Shine J.P., Lu C. A market-representative basket survey of bottled water was initiated in Boston, USA supermarkets. Bottled water classes sampled were: i) non-carbonated (NCR), ii) carbonated (CR), and iii) non-carbonated and enriched (NCRE). Plastic bottle materials sampled were: polyethylene terephthalate (PET), high-density polyethylene (HDPE), polystyrene (PS), and polycarbonate (PC). Storage conditions for the 31 bottled water samples were: 23°C temperature, no-shaking and 12h/12h light/dark for 60days of equilibration. Average Br and Sb concentrations after 60-days of storage followed the order of NCR<CR=NCRE, and NCR<CR<NCRE, respectively, suggesting that the presence of dissolved carbon dioxide in CR samples coupled to additions of flavors and color to NCRE could explain the elevated leaching of Br and Sb. Combining all bottled water classes and plastic material types, a highly significant (p<0.001) correlation was observed between log-transformed soluble Br and Sb concentrations, suggesting similar leaching behavior. Among samples with the highest soluble Br concentrations, BDE-209 congener was qualitatively confirmed in three out of four bottled water samples. The PC, HDPE, and PS samples exhibited significantly (p<0.05) lower Sb and Br leaching than PET. Upon quantitative validation of PBDE leaching from certain plastic bottles into water, a revisit to existing PBDE exposure assessment reports will be deemed necessary. Environment International 2012 10.1016/j.envint.2011.08.007 Co-leaching of brominated compounds and antimony from bottled water
Konstantinos Makris Andra S.S., Makris K.C., Shine J.P. The aim is to investigate the magnitude and variability of antimony (Sb) and bromine (Br) leaching from reused plastic containers (polyethylene terephthalate, PET; and polycarbonate, PC) subject to UV and/or temperature-driven disinfection. The overall objective of this study was to determine the main and interactive effects of temperature, UV exposure duration, and frequency of bottle reuse on the extent of leaching of Sb and Br from plastic bottles into water. Regardless of UV exposure duration, frequency of reuse (up to 27 times) was the major factor that linearly increased Sb leaching from PET bottles at all temperatures tested (13-47 °C). Leached Sb concentrations (∼360 ng L(-1)) from the highly reused (27 times) PET bottles (minimal Sb leaching from PC bottles, <15 ng L(-1)) did not pose a serious risk to human health according to current daily Sb acceptable intake estimates. Leached Br concentrations from both PET and PC containers (up to ∼15 μg L(-1)) did not pose a consumer health risk either, however, no acceptable daily dose estimates exist for oral ingestion of organo-brominated, or other plasticizers/additives compounds if they were to be found in bottled water at much lower concentrations. Water research 2011 10.1016/j.watres.2011.10.001 Frequency of use controls chemical leaching from drinking-water containers subject to disinfection
Konstantinos Makris Linos A., Petralias A., Christophi C.A., Christoforidou E., Kouroutou P., Stoltidis M., Veloudaki A., Tzala E., Makris K.C., Karagas M.R. Hexavalent chromium is a known carcinogen when inhaled, but its carcinogenic potential when orally ingested remains controversial. Water contaminated with hexavalent chromium is a worldwide problem. An ecological mortality study within the Oinofita region of Greece, where water has been contaminated with hexavalent chromium. We calculated gender, age, and period standardized mortality ratios (SMRs) for all deaths, cancer deaths, and specific cancer types of Oinofita residents over an 11-year period (1999 - 2009), using the greater prefecture of Voiotia as the standard population. The SMR for all cause mortality was 98 (95% CI 89-107) and for all cancer mortality 114 (95% CI 94-136). The SMR for primary liver cancer was 1104 (95% CI 405-2403, p-value < 0.001). Furthermore, statistically significantly higher SMRs were identified for lung cancer (SMR = 145, 95% CI 100-203, p-value = 0.047) and cancer of the kidney and other genitourinary organs among women (SMR = 368, 95% CI 119-858, p-value = 0.025). Elevated SMRs for several other cancers were also noted, but these did not reach statistical significance. Elevated cancer mortality in the Oinofita area of Greece supports the hypothesis of hexavalent chromium carcinogenicity via the oral ingestion pathway of exposure. Further studies are needed to determine whether this association is causal, and to establish preventive guidelines and public health recommendations. Environmental health: a global access science source 2011 10.1186/1476-069X-10-50 Oral ingestion of hexavalent chromium through drinking water and cancer mortality in an industrial area of Greece- and ecological study
Konstantinos Makris Andra S.S., Makris K.C. Cigarette and STP are important sources of TSNA to water supplies.  Knowledge on the occurrence and removal of TSNA in water bodies is lacking. Worst-case scenario predicts detectable TSNA levels in wastewater influent. Cancer risk potency of TSNA is similar to that of highly toxic alkyl nitrosamines, such as NDMA. Research is needed to determine TSNA removal efficiencies of wastewater treatments and the quantification of TSNA entry to the drinking-water cycle. If present in drinking water, TSNA concentrations will be relatively low, but the relative health risk remains unexplored, especially when TSNA concentrations in water are expected to increase with STP consumption in the following years. In-vivo experiments showed the carcinogenicity of TSNA in animal models, but epidemiologic studies are still lacking.  Environment International 2011 10.1016/j.envint.2010.11.003 Tabacco-specific nitrosamines in water: an unexplored environmental health risk
Andri Panayiotou Schmidt, A.F.aecucvEmail Author,  Swerdlow, D.I.af,  Holmes, M.V.kl,  Patel, R.S.aen,  Fairhurst-Hunter, Z.m,  Lyall, D.M.o,  Hartwig, F.P.r,  Horta, B.L.r,  Hyppönen, E.suv,  Power, C.u,  Moldovan, M.tw,  van Iperen, E.xy,  Hovingh, G.K.z,  Demuth, I.abac,  Norman, K.ab,  Steinhagen-Thiessen, E.ab,  Demuth, J.ad,  Bertram, L.gae,  Liu, T.afag,  Coassin, S.ah,  Willeit, J.ai,  Kiechl, S.ai,  Willeit, K.ai,  Mason, D.aj,  Wright, J.aj,  Morris, R.ak,  Wanamethee, G.b,  Whincup, P.al,  Ben-Shlomo, Y.ak,  McLachlan, S.am,  Price, J.F.am,  Kivimaki, M.c,  Welch, C.c,  Sanchez-Galvez, A.c,  Marques-Vidal, P.ao,  Nicolaides, A.hap,  Panayiotou, A.G.aq,  Onland-Moret, N.C.ar,  van der Schouw, Y.T.ar,  Matullo, G.atau,  Fiorito, G.atau,  Guarrera, S.atau,  Sacerdote, C.avaw,  Wareham, N.J.ax,  Langenberg, C.ax,  Scott, R.ax,  Luan, J.ax,  Bobak, M.c,  Malyutina, S.ayaz,  Pająk, A.ba,  Kubinova, R.bb,  Tamosiunas, A.bc,  Pikhart, H.c,  Husemoen, L.L.N.bd,  Grarup, N.be,  Pedersen, O.be,  Hansen, T.be,  Linneberg, A.bdbfbg,  Simonsen, K.S.bd,  Cooper, J.d,  Humphries, S.E.d,  Brilliant, M.bh,  Kitchner, T.bh,  Hakonarson, H.bi,  Carrell, D.S.bj,  McCarty, C.A.bk,  Kirchner, H.L.bl,  Larson, E.B.bm,  Crosslin, D.R.bm,  de Andrade, M.bn,  Roden, D.M.bo,  Denny, J.C.bp,  Carty, C.bq,  Hancock, S.br,  Attia, J.br,  Holliday, E.br,  O'Donnell, M.bs,  Yusuf, S.bs,  Chong, M.bs,  Pare, G.bs,  van der Harst, P.xbtbu,  Said, M.A.bt,  Eppinga, R.N.bt,  Verweij, N.bt,  Snieder, H.bv,  Christen, T.bw,  Mook-Kanamori, D.O.bw,  Gustafsson, S.bx,  Lind, L.bx,  Ingelsson, E.bxbybz,  Pazoki, R.ca,  Franco, O.ca,  Hofman, A.ca,  Uitterlinden, A.cb,  Dehghan, A.jca,  Teumer, A.cccg,  Baumeister, S.ccch,  Dörr, M.cdcg,  Lerch, M.M.ce,  Völker, U.cfcg,  Völzke, H.cccg,  Ward, J.o,  Pell, J.P.o,  Smith, D.J.o,  Meade, T.ci,  Maitland-van der Zee, A.H.aacj,  Baranova, E.V.cj,  Young, R.p,  Ford, I.p,  Campbell, A.an,  Padmanabhan, S.q,  Bots, M.L.ar,  Grobbee, D.E.ar,  Froguel, P.ick,  Thuillier, D.ck,  Balkau, B.cl,  Bonnefond, A.ick,  Cariou, B.cm,  Smart, M.cn,  Bao, Y.cn,  Kumari, M.cn,  Mahajan, A.m,  Ridker, P.M.co,  Chasman, D.I.co,  Reiner, A.P.cp,  Lange, L.A.cq,  Ritchie, M.D.crcs,  Asselbergs, F.W.aexaras,  Casas, J.-P.e,  Keating, B.J.ct,  Preiss, D.kl,  Hingorani, A.D.ae,  Sattar, N.q View additional authors.   The Lancet Diabetes and Endocrinology 2017 5(2):97-105  PCSK9 genetic variants and risk of type 2 diabetes: a mendelian randomisation study
Andri Panayiotou Elena Hadjimbei, George Botsaris, Vassilis Gekas, and Andrie G. Panayiotou   Journal of Nutrition and Metabolism  2016 http://dx.doi.org/10.1155/2016/2742841 Adherence to the Mediterranean Diet and Lifestyle Characteristics of University Students in Cyprus: A Cross-Sectional Survey
Andri Panayiotou Stavri Zinonos, Theodora Zachariadou, Savvas Zannetos, Andrie G. Panayiotou and Andreas Georgiou   Tobacco Induced Diseases 2016 14 https://doi.org/10.1186/s12971-016-0079-6 Smoking prevalence and associated risk factors among healthcare professionals in Nicosia general hospital, Cyprus: a cross-sectional study
Andri Panayiotou Nicolaides A, Panayiotou AG   JACC 2016 11(67):1275-77 Editorial: Screening for Atherosclerotic Cardiovascular Risk Using Ul¬trasound
Andri Panayiotou Kousios A, Kouis P and Panayiotou AG   Int J Nephrol  2016 dx.doi. org/10.1155/2016/9498013  Matrix Metalloproteinases and subclinical atheroscle¬rosis in Chronic Kidney Disease: A systematic review
Andri Panayiotou Panayiotou AG   Curr Vasc Pharmacol 2015 13(6):699-700 Editorial: Financial Crisis, Drug Compliance and Cardiovascular Health-the GREECS Case? 
Andri Panayiotou Panayiotou AG, Griffin M, Kouis P, Nicolaides AN   Int Angiol 2015 Oct;34(5):437-44. Epub 2015 Feb 12  Comparison between Insulin Resistance in¬dices and carotid and femoral atherosclerosis: A cross-sectional population study
Andri Panayiotou Holmes MV, Dale CE, Zuccolo L, Silverwood RJ, Guo Y, Ye Z, Prieto-Merino D, Dehghan A, Trompet S, Wong A, Cavadino A, Drogan D, Padmanabhan S, Li S, Yesupriya A, Leusink M, Sundstrom J, Hubacek JA, Pikhart H, Swerdlow DI, Panayiotou AG, Borinskaya SA, Finan C, Shah S, Kuchenbaecker KB, Shah T, En¬gmann J, Folkersen L, Eriksson P, Ricceri F, Melander O, Sacerdote C, Gamble DM, Rayaprolu S, Ross OA, McLachlan S, Vikhireva O, Sluijs I, Scott RA, Adamkova V, Flicker L, Bockxmeer FM, Power C, Marques- Vidal P, Meade T, Marmot MG, Ferro JM, Paulos-Pinheiro S, Humphries SE, Talmud PJ, Mateo Leach I, Verweij N, Linneberg A, Skaaby T, Doevendans PA, Cramer MJ, van der Harst P, Klungel OH, Dowling NF, Dominiczak AF, Kumari M, Nicolaides AN, Weikert C, Boeing H, Ebrahim S, Gaunt TR, Price JF, Lannfelt L, Peasey A, Kubinova R, Pajak A, Malyutina S, Voevoda MI, Tamosiunas A, Maitland-van der Zee AH,
Norman PE, Hankey GJ, Bergmann MM, Hofman A, Franco OH, Cooper J, Palmen J, Spiering W, de Jong PA, Kuh D, Hardy R, Uitterlinden AG, Ikram MA, Ford I, Hyppönen E, Almeida OP, Wareham NJ, Khaw KT, Hamsten A, Husemoen LL, Tjønneland A, Tolstrup JS, Rimm E, Beulens JW, Verschuren WM, Onland-Moret NC, Hofker MH, Wannamethee SG, Whincup PH, Morris R, Vicente AM, Wat¬kins H, Farrall M, Jukema JW, Meschia J, Cupples LA, Sharp SJ, Fornage M, Kooperberg C, LaCroix AZ, Dai JY, Lanktree MB, Siscovick DS, Jorgenson E, Spring B, Coresh J, Li YR, Buxbaum SG, Schreiner PJ, Ellison RC, Tsai MY, Patel SR, Redline S, Johnson AD, Hoogeveen RC, Hakonarson H, Rotter JI, Boerwinkle E, de Bakker PI, Kivimaki M, Asselbergs FW, Sattar N, Lawlor DA, Whittaker J, Davey Smith G, Mukamal K, Psaty BM, Wilson JG, Lange LA, Hamidovic A, Hingorani AD, Nordestgaard BG, Bobak M, Leon DA, Langenberg C, Palmer TM, Reiner AP, Keating BJ, Dudbridge F, Casas JP; InterAct Consortium
  BMJ  2014 Jul 10;349:g4164. doi: 10.1136/bmj.g4164.  Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data
Andri Panayiotou Arking DE, Pulit SL, Crotti L, van der Harst P, Munroe PB, Koopmann TT, Sotoodehnia N, Ros¬sin EJ, Morley M, Wang X, Johnson AD, Lundby A, Gudbjartsson DF, Noseworthy PA, Eij¬gelsheim M, Bradford Y, Tarasov KV, Dörr M, Müller-Nurasyid M, Lahtinen AM, Nolte IM, Smith AV, Bis JC, Isaacs A, Newhouse SJ, Evans DS, Post WS, Waggott D, Lyytikäinen LP, Hicks AA, Eisele L, Ellinghaus D, Hayward C, Navarro P, Ulivi S, Tanaka T, Tester DJ, Chatel S, Gustafsson S, Kumari M, Morris RW, Naluai AT, Padmanabhan S, Kluttig A, Strohmer B, Panayiotou AG, Torres M, Kno¬flach M, Hubacek JA, Slowikowski K, Raychaudhuri S, Kumar RD, Harris TB, Launer LJ, Shuldiner AR, Alonso A, Bader JS, Ehret G, Huang H, Kao WH, Strait JB, Macfarlane PW, Brown M, Caulfield MJ, Samani NJ, Kronenberg F, Willeit J; CARe Consortium; COGENT Consortium, Smith JG, Greiser KH, Meyer Zu Schwabedissen H, Wer-dan K, Carella M, Zelante L, Heckbert SR, Psaty BM, Rotter JI, Kolcic I, Polašek O, Wright AF, Griffin M, Daly MJ; DCCT/EDIC, Arnar DO, Hólm H, Thorsteinsdottir U; eMERGE Consortium, Denny JC, Roden DM, Zuvich RL, Emilsson V, Plump AS, Larson MG, O’Don¬nell CJ, Yin X, Bobbo M, D’Adamo AP, Iorio A, Sinagra G, Carracedo A, Cummings SR, Nalls MA, Jula A, Kontula KK, Marjamaa A, Oikarinen L, Perola M, Porthan K, Erbel R, Hoffmann P, Jöckel KH, Kälsch H, Nöthen MM; HRGEN Consortium, den Hoed M, Loos RJ, Thelle DS, Gieger C, Meitinger T, Perz S, Peters A, Prucha H, Sinner MF, Waldenberger M, de Boer RA, Franke L, van der Vleuten PA, Beckmann BM, Martens E, Bardai A, Hofman N, Wilde AA, Behr ER, Dalageorgou C, Giudices¬si JR, Medeiros-Domingo A, Barc J, Kyndt F, Probst V, Ghidoni A, In-solia R, Hamilton RM, Scherer SW, Brandimarto J, Margulies K, Moravec CE, Greco M FD, Fuchsberger C, O’Connell JR, Lee WK, Watt GC, Campbell H, Wild SH, El Mokhtari NE, Frey N, Asselbergs FW, Mateo Leach I, Navis G, van den Berg MP, van Veldhuisen DJ, Kellis M, Krijthe BP, Franco OH, Hofman A, Kors JA, Uitterlinden AG, Witteman JC, Kedenko L, Lamina C, Oostra BA, Abecasis GR, Lakatta EG, Mulas A, Orrú M, Schlessinger D, Uda M, Markus MR, Völker U, Snieder H, Spector TD, Arnlöv J, Lind L, Sundström J, Syvänen AC, Kivimaki M, Kähönen M, Mononen N, Raitakari OT, Viikari JS, Adamkova V, Kiechl S, Brion M, Nicolaides AN, Paulweber B, Haerting J, Dominiczak AF, Nyberg F, Whincup PH, Hin-gorani AD, Schott JJ, Bezzina CR, Ingelsson E, Ferrucci L, Gasparini P, Wilson JF, Rudan I, Franke A, Mühleisen TW, Pramstaller PP, Lehtimäki TJ, Paterson AD, Parsa A, Liu Y, van Duijn CM, Siscovick DS, Gudnason V, Jamshidi Y, Salomaa V, Felix SB, Sanna S, Ritchie MD, Stricker BH, Stefansson K, Boyer LA, Cappola TP, Olsen JV, Lage K, Schwartz PJ, Kääb S, Chakravarti A, Ackerman MJ, Pfeufer A, de Bakker PI, Newton-Cheh C.    Nat Genet 2014 Aug;46(8):826-36. doi: 10.1038/ng.3014. Epub 2014 Jun 22.  Genetic association study of QT interval highlights role for calcium signaling pathways in myocardi­al repolarization
Andri Panayiotou Kouis P, Pampaka D, Panayiotou AG   EMJ Hepatol 2014 1:62-70 201419  Adipose tissue, metabolic Syndrome and non-alcoholic fatty liver disease-A short review
Andri Panayiotou Voskarides K, Hadjipanagi D, Papazachariou L, Griffin M, Panayiotou AG   Genet Test Mol Biomarkers 2014 Aug;18(8):552-6. doi: 10.1089/gtmb.2014.0020. Epub 2014 Apr 10.  Evidence for contri¬bution of the Y chromosome in atherosclerotic plaque occurrence in men
Andri Panayiotou Owusu Adjah ES, Panayiotou AG   Malar J 2014 Mar 28;13:123. doi: 10.1186/1475- 2875-13-123.  Impact of malaria related messages on insecticide-treated net (ITN) use for malaria prevention in Ghana
Andri Panayiotou Panayiotou AG, Kamilari E, Griffin M, Tyllis T, Georgiou N, Bond D, Hoppensteadt D, Fareed J, Nicolaides A.    Int Angiol 2013 Dec;32(6):599-604 Association between serum levels of pro-metalloproteinase 1, tissue inhibitor of metalloproteinases 1 and 2 and prevalent cardiovascular disease in a population-based study
Andri Panayiotou Panayiotou AG, Griffin MB, Tyllis T, Georgiou N, Bond D, Humphries SE, Nicolaides AN   Vasc Med 2013 Oct;18(5):298-306 Associ¬ation of genotypes at the matrix metalloproteinase (MMP) loci with carotid IMT and presence of carotid and femoral atherosclerotic plaques
Andri Panayiotou Panayiotou AG, Griffin M, Kouis P, Tyllis T, Georgiou N, Bond D, Nicolaides AN.    Diabetol Metab Syndr.  2013 Aug 20;5:44 Association be­tween presence of the metabolic syndrome and its components with carotid intima-media thickness and carotid and femoral plaque area: a population study
Andri Panayiotou Holmes MV, Simon T, Exeter HJ, Folkersen L, Asselbergs FW, Guardiola M, Cooper JA, Palmen J, Hubacek JA, Carruthers KF, Horne BD, Brunisholz KD, Mega JL, van Iperen EP, Li M, Leusink M, Trom¬pet S, Verschuren JJ, Hovingh GK, Dehghan A, Nelson CP, Kotti S, Danchin N, Scholz M, Haase CL, Rothenbacher D, Swerdlow DI, Kuchenbaecker KB, Staines-Urias E, Goel A, van ‘t Hooft F, Gertow K, de Faire U, Panayiotou AG, Tremoli E, Baldassarre D, Veglia F, Holdt LM, Beutner F, Gansevoort RT, Navis GJ, Mateo Leach I, Breitling LP, Brenner H, Thiery J, Dallmeier D, Franco-Cereceda A, Boer JM, Stephens JW, Hofker MH, Tedgui A, Hofman A, Uitterlinden AG, Adamkova V, Pitha J, Onland-Moret NC, Cramer MJ, Nathoe HM, Spiering W, Klungel OH, Kumari M, Whincup PH, Morrow DA, Braund PS, Hall AS, Olsson AG, Doevendans PA, Trip MD, Tobin MD, Hamsten A, Watkins H, Koenig W, Nicolaides AN, Teupser D, Day IN, Carlquist JF, Gaunt TR, Ford I, Sattar N, Tsimikas S, Schwartz GG, Lawlor DA, Morris RW, Sandhu MS, Poledne R, Maitland-van der Zee AH, Khaw KT, Keating BJ, van der Harst P, Price JF, Mehta SR, Yusuf S, Witteman JC, Franco OH, Jukema JW, de Knijff P, Tybjaerg-Hansen A, Rad¬er DJ, Farrall M, Samani NJ, Kivimaki M, Fox KA, Humphries SE, Anderson JL, Boekholdt SM, Palmer TM, Eriksson P, Paré G, Hingorani AD, Sabatine MS, Mallat Z, Casas JP, Talmud PJ.    Am Coll Cardiol 2013 Nov 19;62(21):1966-76 Secretory phospholipase A(2)-IIA and cardiovascular disease: a mendelian randomization study
Andri Panayiotou Griffin M, Nicolaides A, Tyllis T, Georgiou N, Martin RM, Bond D, Panayiotou A, Tziakouri Ch, Dore CJ, Fessas CH   Int Angiol 2010 Jun;29(3):216-25 Plaque area at carotid and common femoral bifurcations and prevalence of clinical cardiovascular disease
Andri Panayiotou Casas JP, Ninio E, Panayiotou A, Palmen J, Cooper JA, Ricketts SL, Sofat R, Nicolaides AN, Corset­ti JP, Fowkes FG, Tzoulaki I, Kumari M, Brunner EJ, Kivimaki M, Marmot MG, Hoffmann MM, Win­kler K, März W, Ye S, Stirnadel HA, Boekholdt SM, Khaw KT, Humphries SE, Sandhu MS, Hingorani, AD, Talmud PJ   Circulation 2010 Jun 1;121(21):2284-93. 20  PLA2G7 genotype, lipoprotein-associated phospholipase A2 activity, and coronary heart disease risk in 10 494 cases and 15 624 controls of European Ancestry
Andri Panayiotou Panayiotou AG, Nicolaides AN, Griffin M, Tyllis T, Georgiou N, Bond D, Martin RM, Hoppen­steadt D, Fareed J, Humphries SE   Atherosclerosis 2010 Jul;211(1):176-81 Leukocyte telomere length is associated with measures of sub­clinical atherosclerosis
Andri Panayiotou Griffin M, Nicolaides A, Tyllis T, Georgiou N, Martin RM, Bond D, Panayiotou A, Tziakouri C, Doré CJ, Fessas C   Vasc Med 2009 Aug;14(3):227-32 Carotid and femoral arterial wall changes and the prevalence of clinical cardio­vascular disease
Andri Panayiotou Panayiotou A, Nicolaides A, Griffin M, Tyllis T, Georgiou N, Martin RM, Bond D, Tziakou­ri-Shiakalli C, Fessas C, Deltas C.    Expert Opin Ther Targets 2009 Jan;13(1):1-11 Serum total homocysteine, folate, 5,10-methylenetetrahydrofolate reductase (MTHFR) 677C>T genotype and subclinical atherosclerosis
Andri Panayiotou Panayiotou A, Griffin M, Georgiou N, Bond D, Tyllis T, Tziakouri-Shiakalli C, Fessas C, Nicolaides A.   Int Angiol 2008 Feb;27(1):74-80 ApoB/ApoA1 ratio and subclinical atherosclerosis