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Hasselbalch RB, Alaour B, Kristensen JH, Couch LS, Kaier TE, Nielsen TL, Plesner LL, Strandkjær N, Schou M, Rydahl C, Goetze JP, Bundgaard H, Marber M, Iversen KK. Hemodialysis and biomarkers of myocardial infarction - a cohort study. Clin Chem Lab Med 2024; 62:361-370. [PMID: 37556843 DOI: 10.1515/cclm-2023-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVES End-stage renal disease is associated with a high risk of cardiovascular disease. We compared the concentration and prognostic ability of high sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) and cardiac myosin-binding protein C (cMyC) among stable hemodialysis patients. METHODS Patients were sampled before and after hemodialysis. We measured hs-cTnI, hs-cTnT and cMyC and used Cox regressions to assess the association between quartiles of concentrations and all-cause mortality and a combination of cardiovascular events and all-cause mortality during follow-up. RESULTS A total of 307 patients were included, 204 males, mean age 66 years (SD 14). Before dialysis, 299 (99 %) had a hs-cTnT concentration above the 99th percentile, compared to 188 (66 %) for cMyC and 35 (11 %) for hs-cTnI. Hs-cTnT (23 %, p<0.001) and hs-cTnI (15 %, p=0.049) but not cMyC (4 %, p=0.256) decreased during dialysis. Follow-up was a median of 924 days (492-957 days); patients in the 3rd and 4th quartiles of hs-cTnT (3rd:HR 3.0, 95 % CI 1.5-5.8, 4th:5.2, 2.7-9.8) and the 4th quartile of hs-cTnI (HR 3.8, 2.2-6.8) had an increased risk of mortality. Both were associated with an increased risk of the combined endpoint for patients in the 3rd and 4th quartiles. cMyC concentrations were not associated with risk of mortality or cardiovascular event. CONCLUSIONS Hs-cTnT was above the 99th percentile in almost all patients. This was less frequent for hs-cTnI and cMyC. High cTn levels were associated with a 3-5-fold higher mortality. This association was not present for cMyC. These findings are important for management of hemodialysis patients.
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Affiliation(s)
- Rasmus Bo Hasselbalch
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Bashir Alaour
- King's College London British Heart Foundation Centre, Rayne Institute, St Thomas' Hospital, London, UK
| | - Jonas Henrik Kristensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Liam S Couch
- King's College London British Heart Foundation Centre, Rayne Institute, St Thomas' Hospital, London, UK
| | - Thomas E Kaier
- King's College London British Heart Foundation Centre, Rayne Institute, St Thomas' Hospital, London, UK
| | - Ture Lange Nielsen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Louis Lind Plesner
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Nina Strandkjær
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Casper Rydahl
- Department of Nephrology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Michael Marber
- King's College London British Heart Foundation Centre, Rayne Institute, St Thomas' Hospital, London, UK
| | - Kasper Karmark Iversen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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2
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Henrik Kristensen J, Amalie Wistisen Koczulab C, Anton Frandsen E, Bo Hasselbalch R, Strandkjær N, Jørgensen N, Østergaard M, Hasse Møller-Sørensen P, Christian Nilsson J, Afzal S, Rørbæk Kamstrup P, Dahl M, Bor MV, Frikke-Schmidt R, Rye Jørgensen N, Rode L, Holmvang L, Kjærgaard J, Evi Bang L, Forman J, Dalhoff K, Bundgaard H, Karmark Iversen K. Kinetics of cardiac troponin and other biomarkers in patients with ST elevation myocardial infarction. Int J Cardiol Heart Vasc 2023; 48:101250. [PMID: 37602285 PMCID: PMC10432699 DOI: 10.1016/j.ijcha.2023.101250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023]
Abstract
Objective To examine changes in concentration, time-to-peak and the ensuing half-life of cardiac biomarkers in patients with myocardial infarction. Methods Blood sampling was performed every third hour within 24 h after percutaneous coronary intervention (PCI) on a cohort of patients with ST elevation myocardial infarction. Cardiac troponin (cTn) was measured by the Dimension Vista, Vitros, Atellica, and Alinity high-sensitivity (hs) cTnI assays, and the Elecsys hs-cTnT assay. Further, creatine kinase (CK), myoglobin, creatine kinase MB (CKMB) and other biomarkers were analyzed. Results A total of 36 patients completed blood sampling (median age 60 years, IQR 56.4-66.5 years; seven women, 19.4%). Hs-cTnI measured by the Vitros assay was the first hs-cTn to peak at 9.1 h (95%-CI 6.2-10.1) after PCI and 11.7 h (95%-CI 10.4-14.8) after symptoms onset. There were no notable differences between hs-cTn assays in regard to time-to-peak. Also, Vitros hs-cTnI reached the highest median ratio of concentration to upper reference level of nearly 2,000. The median half-life from peak concentration ranged from 7.6 h for myoglobin (CI 6.8-8.6) to 17.8 h for CK (CI 6.8-8.6). For hs-cTn assays the median T½ ranged from 12.4 h for the Vista hs-cTnI assay (95%-CI 11.0-14.1 h) to 17.3 h for the Elecsys hs-cTnT (95%-CI 14.9-20.8 h). Conclusions This study updates knowledge on the kinetics of cardiac biomarkers in current clinical use. There was no notable difference in trajectories, time-to-peak or half-life between hs-cTn assays.
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Affiliation(s)
- Jonas Henrik Kristensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Clara Amalie Wistisen Koczulab
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
| | - Emil Anton Frandsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Rasmus Bo Hasselbalch
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Nina Strandkjær
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Nicoline Jørgensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
| | - Morten Østergaard
- Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Peter Hasse Møller-Sørensen
- Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jens Christian Nilsson
- Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Shoaib Afzal
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
| | - Pia Rørbæk Kamstrup
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
| | - Morten Dahl
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Department of Clinical Biochemistry, Zealand University Hospital – Køge, Lykkebækvej 1, 4600 Køge, Denmark
| | - Mustafa Vakur Bor
- Department of Clinical Biochemistry, University Hospital of Southern Denmark, Finsensgade 35, 6700 Esbjerg, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Line Rode
- Department of Clinical Biochemistry, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lia Evi Bang
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Julie Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark
| | - Kim Dalhoff
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Department of Clinical Pharmacology, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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3
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Hasselbalch RB, Kristensen JH, Strandkjær N, Jørgensen N, Bundgaard H, Malmendal A, Iversen KK. Metabolomics of early myocardial ischemia. Metabolomics 2023; 19:33. [PMID: 37002479 PMCID: PMC10066099 DOI: 10.1007/s11306-023-01999-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 03/14/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Diagnosing myocardial infarction is difficult during the initial phase. As, acute myocardial ischemia is associated with changes in metabolic pathways, metabolomics may provide ways of identifying early stages of ischemia. We investigated the changes in metabolites after induced ischemia in humans using nuclear magnetic resonance spectroscopy (NMR). METHODS We included patients undergoing elective coronary angiography showing normal coronary arteries. These were randomized into 4 groups and underwent coronary artery occlusion for 0, 30, 60 or 90 s. Blood was collected over the next 3 h and analyzed using NMR. We used 2-way ANOVA of time from baseline- and treatment group to find metabolites that changed significantly following the intervention and principal component analysis (PCA) to investigate changes between the 90 s ischemia- and control groups at 15 and 60 min after intervention. RESULTS We included 34 patients. The most pronounced changes were observed in the lipid metabolism where 38 of 112 lipoprotein parameters (34%) showed a significant difference between the patients exposed to ischemia and the control group. There was a decrease in total plasma triglycerides over the first hour followed by a normalization. The principal component analysis showed a effects of the treatment after just 15 min. These effects were dominated by changes in high-density lipoprotein. An increase in lactic acid levels was detected surprisingly late, 1-2 h after the ischemia. CONCLUSION We investigated the earliest changes in metabolites of patients undergoing brief myocardial ischemia and found that ischemia led to changes throughout the lipid metabolism as early as 15 min post-intervention.
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Affiliation(s)
- Rasmus Bo Hasselbalch
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark.
- Department of Cardiology Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Department of Emergency Medicine, Department of Cardiology, Herlev and Gentofte Hospital, Borgmester Ib Juuls vej 1, Herlev, DK-2730, Denmark.
| | - Jonas Henrik Kristensen
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Cardiology Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nina Strandkjær
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Cardiology Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicoline Jørgensen
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Cardiology Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders Malmendal
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Kasper Karmark Iversen
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Cardiology Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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4
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Bock M, Theut AM, van Hasselt JGC, Wang H, Fuursted K, Høiby N, Lerche CJ, Ihlemann N, Gill S, Christiansen U, Nielsen HL, Lemming L, Elming H, Povlsen JA, Bruun NE, Høfsten D, Fosbøl EL, Køber L, Schultz M, Pries-Heje MM, Kristensen JH, Christensen JJ, Rosenvinge FS, Pedersen CT, Helweg-Larsen J, Tønder N, Iversen K, Bundgaard H, Moser C. Attainment of target antibiotic levels by oral treatment of left-sided infective endocarditis: a POET substudy. Clin Infect Dis 2023:7083738. [PMID: 36947131 DOI: 10.1093/cid/ciad168] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND In the POET (Partial Oral Endocarditis Treatment) trial, oral step-down therapy was noninferior to full-length intravenous antibiotic administration. The aim of the present study was to perform pharmacokinetic/pharmacodynamic analyses for oral treatments of infective endocarditis to assess the probabilities of target attainment (PTAs). METHODS Plasma concentrations of oral antibiotics were measured at day 1 and 5. Minimal inhibitory concentrations (MICs) were determined for the bacteria causing infective endocarditis (streptococci, staphylococci, or enterococci). Pharmacokinetic/pharmacodynamic targets were predefined according to literature using time above MIC or the ratio of area under the curve to MIC. Population pharmacokinetic modeling and pharmacokinetic/pharmacodynamic analyses were done for amoxicillin, dicloxacillin, linezolid, moxifloxacin, and rifampicin, and PTAs were calculated. RESULTS A total of 236 patients participated in this POET substudy. For amoxicillin and linezolid, the PTAs were 88%-100%. For moxifloxacin and rifampicin, the PTAs were 71%-100%. Using a clinical breakpoint for staphylococci, the PTAs for dicloxacillin were 9%-17%.Seventy-four patients at day 1 and 65 patients at day 5 had available pharmacokinetic and MIC data for two oral antibiotics. Of those, 13 patients at day 1 and 14 patients at day 5 did only reach the target for one antibiotic. One patient did not reach target for any of the two antibiotics. CONCLUSION For the individual orally administered antibiotic, the majority of patients reached the target level. Patients with sub-target levels were compensated by the administration of two different antibiotics. The findings support the efficacy of oral step-down antibiotic treatment in patients with infective endocarditis.
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Affiliation(s)
- Magnus Bock
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anna Marie Theut
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Johan G C van Hasselt
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Hengzhuang Wang
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Kurt Fuursted
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Niels Høiby
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Christian Johann Lerche
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Nikolaj Ihlemann
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Sabine Gill
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Hans Linde Nielsen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Lemming
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hanne Elming
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Jonas A Povlsen
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Niels Eske Bruun
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Dan Høfsten
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Martin Schultz
- Department of Internal Medicine, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Mia M Pries-Heje
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jonas Henrik Kristensen
- Department of Cardiology, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Jens Jørgen Christensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The Regional Department of Clinical Microbiology, Region Zealand, Denmark
| | - Flemming S Rosenvinge
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | - Christian Torp Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jannik Helweg-Larsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels Tønder
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Kasper Iversen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
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5
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Hasselbalch RB, Kristensen JH, Jørgensen N, Strandkjær N, Alaour B, Afzal S, Marber M, Bundgaard H, Iversen KK. High incidence of discrepancies in new Siemens assay - A comparison of cardiac troponin I assays. Clin Chem Lab Med 2022; 60:921-929. [PMID: 35411761 DOI: 10.1515/cclm-2022-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/28/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiac Troponin (cTn) is the biochemical gold standard for diagnosing myocardial infarction (MI). We compared the Siemens ADVIA Centaur high-sensitivity (hs-cTnI) assay with the Siemens Ultra assay (cTnI-U). METHODS Over 3 months cTnI-U and hs-cTnI were measured simultaneously at Herlev-Gentofte Hospital. Acute myocardial injury was diagnosed using the 4th universal definition. Disputed cases were adjudicated using clinical data. We compared diagnostic accuracy using area under the curve (AUC) of the receiver operating characteristic. Outliers in between-assay differences were defined as a factor-5 difference and ≥1 measurement >40 ng/L. Patients with outlier differences were invited for re-sampling and tested with serial dilution and heterophilic blocking tubes. RESULTS From the 18th January to the 20th April 2019, 4,369 samples on 2,658 patients were included. cTnI-U measured higher concentrations than hs-cTnI (mean 23%, -52-213%), resulting in a higher frequency of acute myocardial injury, 255 (9.6%) vs 203 (7.6%), p<0.001. This remained significant after adjudication, 212 vs 197, p<0.001. AUC for the prediction of MI for was 0.963 for cTnI-U and 0.959 for hs-cTnI, p=0.001. Outlier differences were seen in 35 (1.2%) patients, primarily with elevated hs-cTnI (n=33, 94%). On two re-samplings (median 144 and 297 days since inclusion), 16 of 20 (80%) and 11 of 11 had sustained elevation of hs-cTnI. The samples showed no signs of heterophilic antibodies. CONCLUSIONS Using hs-cTnI resulted in a subset of patients with large, discrepant elevations in concentration. These patients still had elevated hs-cTnI 6-10 months post admission but no heterophilic antibodies.
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Affiliation(s)
- Rasmus Bo Hasselbalch
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Cardiology Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Jonas Henrik Kristensen
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Cardiology Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Nicoline Jørgensen
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Cardiology Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Nina Strandkjær
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Cardiology Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Bashir Alaour
- King's College London British Heart Foundation Centre, Rayne Institute, St Thomas' Hospital, London, UK
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Michael Marber
- King's College London British Heart Foundation Centre, Rayne Institute, St Thomas' Hospital, London, UK
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Cardiology Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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6
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Kristensen JH, Hasselbalch RB, Pries-Heje M, Nielsen PB, Dehlbæk Knudsen A, Fogh K, Boesgaard Norsk J, Eiken A, Andersen O, Fischer TK, Juul Jensen CA, Torp-Pedersen C, Rungby J, Ditlev SB, Hageman I, Møgelvang R, Gybel-Brask M, Dessau RB, Sørensen E, Harritshøj L, Folke F, Engel Møller ME, Benfield T, Ullum H, Jørgensen CS, Rye Ostrowski S, Nielsen SD, Bundgaard H, Iversen K. Effect of influenza vaccination on risk of COVID-19 - A prospective cohort study of 46,000 health care workers. J Infect Dis 2022; 226:6-10. [PMID: 34989811 PMCID: PMC8755365 DOI: 10.1093/infdis/jiac001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/04/2022] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study was to assess if influenza vaccination has an impact on the risk of COVID-19. A cohort of 46,112 health care workers were tested for antibodies against SARS-CoV-2 and filled in a survey on COVID-19 symptoms, hospitalization, and influenza vaccination. The RR of hospitalization due to SARS-CoV-2 for influenza vaccinated compared with unvaccinated participants was 1.00 for the seasonal vaccination in 2019/2020 (CI 0.56-1.78, p=1.00). Likewise, no clinical effect of influenza vaccination on development of antibodies against SARS-CoV-2 was found. The present findings indicate that influenza vaccination does not affect the risk of SARS-CoV-2 infection or COVID-19.
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Affiliation(s)
- Jonas Henrik Kristensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Rasmus Bo Hasselbalch
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Mia Pries-Heje
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Pernille Brok Nielsen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Andreas Dehlbæk Knudsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Infectious Disease, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Kamille Fogh
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Jakob Boesgaard Norsk
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Aleksander Eiken
- Department of Endocrinology and Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23. 2400 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Ove Andersen
- Department of Emergency and Department of Clinical Research, Copenhagen University Hospital - Amager og Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Thea Kølsen Fischer
- Department of Clinical Research, Copenhagen University Hospital - Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark.,Department of Public Health, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Claus Antonio Juul Jensen
- Department of Clinical Biochemistry, Copenhagen University Hospital - Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Research, Copenhagen University Hospital - Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark.,Department of Public Health, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Jørgen Rungby
- Department of Endocrinology and Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23. 2400 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Sisse Bolm Ditlev
- Department of Pulmonary Medicine and Copenhagen Center for Translational Research, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Ida Hageman
- Mental Health Services - The Capital Region of Denmark, Kristineberg 3, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Mikkel Gybel-Brask
- Department of Clinical Immunology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Ram Benny Dessau
- Department of Clinical Microbiology, Zealand University Hospital - Slagelse, Ingemannsvej 46, 4200 Slagelse, Denmark.,Institut for Regional Sundhedsforskning, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Lene Harritshøj
- Department of Clinical Immunology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark.,Copenhagen University Hospital - Copenhagen Emergency Medical Services, Telegrafvej 5A, Stairway 2, 2750 Ballerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Maria Elizabeth Engel Møller
- Department of Infectious Disease, Copenhagen University Hospital - Amager and Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark
| | - Thomas Benfield
- Department of Infectious Disease, Copenhagen University Hospital - Amager and Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Henrik Ullum
- Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark
| | | | - Sisse Rye Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Disease, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730 Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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7
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Iversen K, Kristensen JH, Hasselbalch RB, Pries-Heje M, Nielsen PB, Knudsen AD, Fogh K, Norsk JB, Andersen O, Fischer TK, Juul Jensen CA, Torp-Pedersen C, Rungby J, Ditlev SB, Hageman I, Møgelvang R, Gybel-Brask M, Dessau RB, Sørensen E, Harritshøj L, Folke F, Sten C, Engel Møller ME, Benfield T, Ullum H, Jørgensen CS, Erikstrup C, Ostrowski SR, Nielsen SD, Bundgaard H. Seroprevalence of SARS-CoV-2 antibodies and reduced risk of reinfection through 6 months: a Danish observational cohort study of 44 000 healthcare workers. Clin Microbiol Infect 2021; 28:710-717. [PMID: 34543759 PMCID: PMC8447554 DOI: 10.1016/j.cmi.2021.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Antibodies to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are a key factor in protecting against coronavirus disease 2019 (COVID-19). We examined longitudinal changes in seroprevalence in healthcare workers (HCWs) in Copenhagen and the protective effect of antibodies against SARS-CoV-2. METHODS In this prospective study, screening for antibodies against SARS-CoV-2 (ELISA) was offered to HCWs three times over 6 months. HCW characteristics were obtained by questionnaires. The study was registered at ClinicalTrials.gov, NCT04346186. RESULTS From April to October 2020 we screened 44 698 HCWs, of whom 2811 were seropositive at least once. The seroprevalence increased from 4.0% (1501/37 452) to 7.4% (2022/27 457) during the period (p < 0.001) and was significantly higher than in non-HCWs. Frontline HCWs had a significantly increased risk of seropositivity compared to non-frontline HCWs, with risk ratios (RRs) at the three rounds of 1.49 (95%CI 1.34-1.65, p < 0.001), 1.52 (1.39-1.68, p < 0.001) and 1.50 (1.38-1.64, p < 0.001). The seroprevalence was 1.42- to 2.25-fold higher (p < 0.001) in HCWs from dedicated COVID-19 wards than in other frontline HCWs. Seropositive HCWs had an RR of 0.35 (0.15-0.85, p 0.012) of reinfection during the following 6 months, and 2115 out of 2248 (95%) of those who were seropositive during rounds one or two remained seropositive after 4-6 months. The 133 of 2248 participants (5.0%) who seroreverted were slightly older and reported fewer symptoms than other seropositive participants. CONCLUSIONS HCWs remained at increased risk of infection with SARS-CoV-2 during the 6-month period. Seropositivity against SARS-CoV-2 persisted for at least 6 months in the vast majority of HCWs and was associated with a significantly lower risk of reinfection.
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Affiliation(s)
- Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Emergency Medicine, Copenhagen University Hospital-Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
| | - Jonas Henrik Kristensen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Emergency Medicine, Copenhagen University Hospital-Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Rasmus Bo Hasselbalch
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Emergency Medicine, Copenhagen University Hospital-Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Mia Pries-Heje
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Pernille Brok Nielsen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Emergency Medicine, Copenhagen University Hospital-Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Andreas Dehlbæk Knudsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark; Department of Infectious Disease, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Kamille Fogh
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Emergency Medicine, Copenhagen University Hospital-Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Jakob Boesgaard Norsk
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Emergency Medicine, Copenhagen University Hospital-Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
| | - Ove Andersen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Emergency and Department of Clinical Research, Copenhagen University Hospital-Amager og Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Denmark
| | - Thea Køhler Fischer
- Department of Clinical Research, Copenhagen University Hospital-Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Claus Antonio Juul Jensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Biochemistry, Copenhagen University Hospital-Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Research, Copenhagen University Hospital-Nordsjællands Hospital, Dyrehavevej 29, 3400, Hillerød, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Rungby
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Endocrinology and Copenhagen Center for Translational Research, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400, København NV, Denmark
| | - Sisse Bolm Ditlev
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Pulmonary Medicine and Copenhagen Center for Translational Research, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark
| | - Ida Hageman
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Mental Health Services-The Capital Region of Denmark, Kristineberg 3, 2100, København Ø, Denmark
| | - Rasmus Møgelvang
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Mikkel Gybel-Brask
- Department of Clinical Immunology, Copenhagen University Hospital-Rigshospitalet, Inge Lehmans Vej 7, 2100, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Zealand University Hospital-Slagelse, Ingemannsvej 46, 4200, Slagelse, Denmark; University of Southern Denmark, Odense, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Copenhagen University Hospital-Rigshospitalet, Inge Lehmans Vej 7, 2100, Copenhagen, Denmark
| | - Lene Harritshøj
- Department of Clinical Immunology, Copenhagen University Hospital-Rigshospitalet, Inge Lehmans Vej 7, 2100, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Copenhagen University Hospital-Copenhagen Emergency Medical Services, Copenhagen, Denmark; Copenhagen University Hospital-Copenhagen Emergency Medical Services, Telegrafvej 5A, Stairway 2, 2750, Ballerup, Denmark
| | - Curt Sten
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Diagnostisk Enhed, Copenhagen University Hospital-Bornholm, Ullasvej 8, 3700, Rønne, Denmark
| | - Maria Elizabeth Engel Møller
- Department of Infectious Disease, Copenhagen University Hospital-Amager and Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark
| | - Thomas Benfield
- Department of Infectious Disease, Copenhagen University Hospital-Amager and Hvidovre, Kettegaard Alle 30, 2650 Hvidovre, Denmark
| | - Henrik Ullum
- Statens Serum Institut, Artillerivej 5, 2300, København S, Copenhagen, Denmark
| | | | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark
| | - Sisse R Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital-Rigshospitalet, Inge Lehmans Vej 7, 2100, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Infectious Disease, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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8
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Harritshøj LH, Gybel-Brask M, Afzal S, Kamstrup PR, Jørgensen CS, Thomsen MK, Hilsted L, Friis-Hansen L, Szecsi PB, Pedersen L, Nielsen L, Hansen CB, Garred P, Korsholm TL, Mikkelsen S, Nielsen KO, Møller BK, Hansen AT, Iversen KK, Nielsen PB, Hasselbalch RB, Fogh K, Norsk JB, Kristensen JH, Schønning K, Kirkby NS, Nielsen ACY, Landsy LH, Loftager M, Holm DK, Nilsson AC, Sækmose SG, Grum-Schwensen B, Aagaard B, Jensen TG, Nielsen DM, Ullum H, Dessau RB. Comparison of 16 Serological SARS-CoV-2 Immunoassays in 16 Clinical Laboratories. J Clin Microbiol 2021; 59:e02596-20. [PMID: 33574119 PMCID: PMC8091860 DOI: 10.1128/jcm.02596-20] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/09/2021] [Indexed: 01/09/2023] Open
Abstract
Serological assays for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are needed to support clinical diagnosis and epidemiological investigations. Recently, assays for large-scale detection of total antibodies (Ab), immunoglobulin G (IgG), and IgM against SARS-CoV-2 antigens have been developed, but there are limited data on the diagnostic accuracy of these assays. This study was a Danish national collaboration and evaluated 15 commercial and one in-house anti-SARS-CoV-2 assays in 16 laboratories. Sensitivity was evaluated using 150 samples from individuals with asymptomatic, mild, or moderate COVID-19, nonhospitalized or hospitalized, confirmed by nucleic acid amplification tests (NAAT); samples were collected 13 to 73 days either from symptom onset or from positive NAAT (patients without symptoms). Specificity and cross-reactivity were evaluated in samples collected prior to the SARS-CoV-2 epidemic from >586 blood donors and patients with autoimmune diseases, cytomegalovirus or Epstein-Barr virus infections, and acute viral infections. A specificity of ≥99% was achieved by all total-Ab and IgG assays except one, DiaSorin Liaison XL IgG (97.2%). Sensitivities in descending order were Wantai ELISA total Ab (96.7%), CUH-NOVO in-house ELISA total Ab (96.0%), Ortho Vitros total Ab (95.3%), YHLO iFlash IgG (94.0%), Ortho Vitros IgG (93.3%), Siemens Atellica total Ab (93.2%), Roche Elecsys total Ab (92.7%), Abbott Architect IgG (90.0%), Abbott Alinity IgG (median 88.0%), DiaSorin Liaison XL IgG (median 84.6%), Siemens Vista total Ab (81.0%), Euroimmun/ELISA IgG (78.0%), and Snibe Maglumi IgG (median 78.0%). However, confidence intervals overlapped for several assays. The IgM results were variable, with the Wantai IgM ELISA showing the highest sensitivity (82.7%) and specificity (99%). The rate of seropositivity increased with time from symptom onset and symptom severity.
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Affiliation(s)
- Lene H Harritshøj
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Gybel-Brask
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pia R Kamstrup
- Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Charlotte S Jørgensen
- Department of Virus & Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | | | - Linda Hilsted
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lennart Friis-Hansen
- Department of Clinical Biochemistry, Copenhagen University Hospital, Bispebjerg, and Frederiksberg Hospital, Copenhagen, Denmark
| | - Pal B Szecsi
- Department of Clinical Biochemistry, Holbæk Hospital, Holbæk, Denmark
| | - Lise Pedersen
- Department of Clinical Biochemistry, Holbæk Hospital, Holbæk, Denmark
| | - Lene Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Cecilie B Hansen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Trine-Line Korsholm
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Susan Mikkelsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Kirstine O Nielsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Bjarne K Møller
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne T Hansen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kasper K Iversen
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Pernille B Nielsen
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Rasmus B Hasselbalch
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Kamille Fogh
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Jakob B Norsk
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Jonas Henrik Kristensen
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Kristian Schønning
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nikolai S Kirkby
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Alex C Y Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lone H Landsy
- Department of Nonclinical and Clinical Assay Sciences in Global Discovery & Development Sciences, Novo Nordisk A/S, Måløv, Denmark
| | - Mette Loftager
- Department of Nonclinical and Clinical Assay Sciences in Global Discovery & Development Sciences, Novo Nordisk A/S, Måløv, Denmark
| | - Dorte K Holm
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Anna C Nilsson
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Susanne G Sækmose
- Department of Clinical Immunology, Zealand University Hospital, Næstved Hospital, Næstved, Denmark
| | - Birgitte Grum-Schwensen
- Department of Clinical Immunology, Zealand University Hospital, Næstved Hospital, Næstved, Denmark
| | - Bitten Aagaard
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Thøger G Jensen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
- Research Unit for Clinical Microbiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Dorte M Nielsen
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse Hospital, Slagelse, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Statens Serum Institut, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse Hospital, Slagelse, Denmark
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9
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Hasselbalch RB, Kristensen JH, Nielsen TL, Plesner LL, Rydahl C, Schou M, Goetze JP, Bundgaard H, Iversen KK. Mid-regional pro-atrial natriuretic peptide levels before and after hemodialysis predict long-term prognosis. Clin Biochem 2021; 94:20-26. [PMID: 33865815 DOI: 10.1016/j.clinbiochem.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mid-regional pro-atrial natriuretic peptide (MR-proANP) is a strong prognostic biomarker in cardiovascular disease but there is limited data for its use among patients undergoing dialysis. METHODS This was a cohort study of patients receiving maintenance hemodialysis from two Danish centers. Blood sampling and echocardiography were performed before and after a dialysis session. We calculated the area under the curve (AUC) for the receiver operating characteristics for diagnosing heart failure and Cox regressions for cardiovascular events and all-cause mortality. RESULTS Of the 306 patients, 284 (93%) had MR-proANP measurements both before and after dialysis. Median concentration was 642 pmol/L (IQR 419-858) before and 351 pmol/L (IQR 197-537) after dialysis, a mean decrease of 330 pmol/L (43%, CI 296-364, P < 0.001). MR-proANP concentration both before and after dialysis was negatively correlated to left ventricular ejection fraction with no difference in predictive ability for heart failure, AUC before and after dialysis were 0.60 (CI 0.50-0.70) and 0.61 (CI 0.51-0.71) (P = 0.40). Median follow-up was 32 months (IQR 31-33), during which 99 patients (32%) had a cardiovascular event and 110 (36%) died. A doubling of MR-proANP concentration was associated with a hazard ratio (HR) of 1.6 (CI 1.3-1.9) before and 1.7 (CI 1.4-2.0) after dialysis for mortality and a HR of 1.5 (CI 1.2-1.9) before and 1.4 (CI 1.2-1.7) after dialysis for cardiovascular events (all P < 0.001). CONCLUSION The MR-proANP concentration is elevated among patients undergoing hemodialysis and decreases during dialysis. MR-proANP concentration both before, after and intra-dialysis change strongly predicted cardiovascular events and all-cause mortality.
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Affiliation(s)
- Rasmus Bo Hasselbalch
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.
| | | | - Ture Lange Nielsen
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Louis Lind Plesner
- Department of Emergency Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Casper Rydahl
- Department of Nephrology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
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Kristensen JH, Larsen L, Dasgupta B, Brodmerkel C, Curran M, Karsdal MA, Sand JMB, Willumsen N, Knox AJ, Bolton CE, Johnson SR, Hägglund P, Svensson B, Leeming DJ. Levels of circulating MMP-7 degraded elastin are elevated in pulmonary disorders. Clin Biochem 2015; 48:1083-8. [PMID: 26164539 DOI: 10.1016/j.clinbiochem.2015.07.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 07/03/2015] [Accepted: 07/04/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Elastin is a signature protein of the lungs. Matrix metalloproteinase-7 (MMP-7) is important in lung defence mechanisms and degrades elastin. However, MMP-7 activity in regard to elastin degradation has never been quantified serologically in patients with lung diseases. An assay for the quantification of MMP-7 generated elastin fragments (ELM7) was therefore developed to investigate MMP-7 derived elastin degradation in pulmonary disorders such as idiopathic pulmonary fibrosis (IPF) and lung cancer. DESIGN AND METHODS Monoclonal antibodies (mABs) were raised against eight carefully selected MMP-7 cleavage sites on elastin. After characterisation and validation of the mABs, one mAB targeting the ELM7 fragment was chosen. ELM7 fragment levels were assessed in serum samples from patients diagnosed with IPF (n=123, baseline samples, CTgov reg. NCT00786201), and lung cancer (n=40) and compared with age- and sex-matched controls. RESULTS The ELM7 assay was specific towards in vitro MMP-7 degraded elastin and the ELM7 neoepitope but not towards other MMP-7 derived elastin fragments. Serum ELM7 levels were significantly increased in IPF (113%, p<0.0001) and lung cancer (96%, p<0.0001) compared to matched controls. CONCLUSIONS MMP-7-generated elastin fragments can be quantified in serum and may reflect pathological lung tissue turnover in several important lung diseases.
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Affiliation(s)
- J H Kristensen
- Nordic Bioscience A/S, Herlev, Denmark; The Technical University of Denmark, Department of Systems Biology, Kgs. Lyngby, Denmark.
| | - L Larsen
- Nordic Bioscience A/S, Herlev, Denmark
| | - B Dasgupta
- Janssen Research and Development, LLC, Spring House, PA, USA
| | - C Brodmerkel
- Janssen Research and Development, LLC, Spring House, PA, USA
| | - M Curran
- Janssen Research and Development, LLC, Spring House, PA, USA
| | | | | | | | - A J Knox
- Division of Respiratory Medicine and Respiratory Research Unit, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - C E Bolton
- Division of Respiratory Medicine and Respiratory Research Unit, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - S R Johnson
- Division of Respiratory Medicine and Respiratory Research Unit, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - P Hägglund
- The Technical University of Denmark, Department of Systems Biology, Kgs. Lyngby, Denmark
| | - B Svensson
- The Technical University of Denmark, Department of Systems Biology, Kgs. Lyngby, Denmark
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Abstract
AIMS To investigate the transfer of mirtazapine and desmethylmirtazapine into milk and to calculate dose to the infant via milk. METHODS Plasma and milk samples were obtained from eight breast-feeding women who were taking a median dose of 38 mg mirtazapine per day. Milk/plasma ratio (M/P) and infant doses were estimated by standard methods. The infants were examined clinically and in four infants blood was taken for analysis. RESULTS Mean (95% confidence interval) relative infant doses for mirtazapine and desmethylmirtazapine (n = 8) were 1.5% (0.8, 2.2) and 0.4% (0.2, 0.6) respectively. The mean M/P (area under curve n = 4, single or paired samples n = 3) was 1.1 (0.7,1.5) for mirtazapine and 0.6 (0.5, 0.7) for desmethylmirtazapine. No adverse effects were seen. Mirtazapine was detected (1.5 microg l(-1)) in only one of four infants tested. CONCLUSION We suggest that mirtazapine use by lactating women is safe for the breast-fed infant. Nevertheless, each decision to breast feed should always be made on the basis of an individual risk/benefit analysis.
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Affiliation(s)
- J H Kristensen
- Pharmacy Department, Women's and Children's Health Service, Subiaco, Australia
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Abstract
AIMS/HYPOTHESIS The aim of this study was to characterize the milk-to-plasma ratio and infant dose for metformin in breastfeeding women, and to measure plasma concentrations and assess any effects in their infants. We hypothesized that metformin used by mothers is safe for their breastfed infants. METHODS Seven women taking metformin (median dose 1500 mg orally daily) and their infants were studied. Metformin concentrations in plasma and milk were measured by high performance liquid chromatography. Infant exposure was estimated as the product of estimated milk production rate and the average concentration of the drug in milk and also expressed as a percentage of the weight-normalized maternal dose. RESULTS The mean milk-to-plasma ratio for metformin was 0.35 (95%CI 0.2-0.5). The mean of its average concentrations in milk over the dose interval was 0.27 mg/l (0.15-0.39 mg/l). The absolute infant dose averaged 0.04 mg x kg(-1) x day(-1) (0.02-0.06 mg x kg(-1) x day(-1)) and the mean relative infant dose was 0.28% (0.16-0.4%). Metformin was present in very low or undetectable concentrations in the plasma of four of the infants who were studied. No health problems were found in the six infants who were evaluated. CONCLUSIONS/INTERPRETATION The concentrations of metformin in breast milk were generally low and the mean infant exposure to the drug was only 0.28% of the weight-normalized maternal dose. As this is well below the 10% level of concern for breastfeeding, and because the infants were healthy, we conclude that metformin use by breastfeeding mothers is safe. Nevertheless, each decision to breastfeed should be made after conducting a risk:benefit analysis for each mother and her infant.
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Affiliation(s)
- T W Hale
- Department of Pediatrics, Division of Clinical Pharmacology, Texas Tech University School of Medicine, Amarillo, Texas, USA.
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14
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Randers E, Erlandsen EJ, Kristensen JH, Markussen S, Pedersen OL, Danielsen H, Jørgensen PE. Serum hepatocyte growth factor levels in patients with chronic renal disease--effect of GFR and pathogenesis. Scand J Clin Lab Invest 2002; 61:615-9. [PMID: 11768321 DOI: 10.1080/003655101753267973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
UNLABELLED Hepatocyte growth factor (HGF) is a growth-promoting peptide that appears to act in a renotropic and nephroprotective manner during acute renal damage. Recent studies suggest that HGF is also of importance in chronic renal diseases. The serum HGF level is correlated with serum creatinine, and it has been suggested that glomerular and tubular diseases affect serum HGF differently. In the present study. levels of serum HGF were determined and correlated to glomerular filtration rate (GFR) in 118 patients with various chronic renal diseases. GFR was determined by 99mTc-DTPA clearance, and the GFR values were evenly distributed in the interval 5-155 mL/min/1.73 m2. Serum HGF levels increased slightly with decreasing GFR: the Pearson correlation coefficient being 0.49 (p<0.0001). In 21 additional patients with end-stage renal disease treated with continuous ambulatory peritoneal dialysis, there was a more marked increase in the serum levels of HGF. The effect of glomerular and tubular diseases on serum HGF was examined by comparing the HGF levels in two groups of patients with similar GFR values: 57 patients with mainly glomerular disorders (diabetic nephropathy with micro- or macroalbuminuria or glomerulonephritis) and 14 patients with mainly tubular disorders (polycystic kidney disease). There was no significant difference between the HGF levels of the two groups (p=0.30). IN CONCLUSION Serum HGF levels are correlated with GFR (for GFR > or = 5 mL/min/1.73 m2) in patients with chronic renal diseases, and glomerular and tubular disorders seem to affect the HGF level similarly.
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Affiliation(s)
- E Randers
- Department of Internal Medicine, Viborg-Kjellerup County Hospital, Viborg, Denmark.
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15
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Krzywkowski K, Petersen EW, Ostrowski K, Kristensen JH, Boza J, Pedersen BK. Effect of glutamine supplementation on exercise-induced changes in lymphocyte function. Am J Physiol Cell Physiol 2001; 281:C1259-65. [PMID: 11546663 DOI: 10.1152/ajpcell.2001.281.4.c1259] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to investigate the possible role of glutamine in exercise-induced impairment of lymphocyte function. Ten male athletes participated in a randomized, placebo-controlled, double-blind crossover study. Each athlete performed bicycle exercise for 2 h at 75% of maximum O(2) consumption on 2 separate days. Glutamine or placebo supplements were given orally during and up to 2 h postexercise. The trial induced postexercise neutrocytosis that lasted at least 2 h. The total lymphocyte count increased by the end of exercise due to increase of both CD3(+)TCR alpha beta(+) and CD3(+)TCR gamma delta(+) T cells as well as CD3(-)CD16(+)CD56(+) natural killer (NK) cells. Concentrations of CD8(+) and CD4(+) T cells lacking CD28 and CD95 on their surface increased more than those of cells expressing these receptors. Within the CD4(+) cells, only CD45RA(-) memory cells, but not CD45RA(+) naive cells, increased in response to exercise. Most lymphocyte subpopulations decreased 2 h after exercise. Glutamine supplementation abolished the postexercise decline in plasma glutamine concentration but had no effect on lymphocyte trafficking, NK and lymphokine-activated killer cell activities, T cell proliferation, catecholamines, growth hormone, insulin, or glucose. Neutrocytosis was less pronounced in the glutamine-supplemented group, but it is unlikely that this finding is of any clinical significance. This study does not support the idea that glutamine plays a mechanistic role in exercise-induced immune changes.
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Affiliation(s)
- K Krzywkowski
- Copenhagen Muscle Research Centre and Department of Infectious Diseases, Rigshospitalet, 2200 Copenhagen N, Denmark
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16
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Dickmeiss E, Kristensen JH. [Respecting the donor blood]. Ugeskr Laeger 2001; 163:138. [PMID: 11379234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
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Yapp P, Ilett KF, Kristensen JH, Hackett LP, Paech MJ, Rampono J. Drowsiness and poor feeding in a breast-fed infant: association with nefazodone and its metabolites. Ann Pharmacother 2000; 34:1269-72. [PMID: 11098340 DOI: 10.1345/aph.10120] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To investigate whether adverse effects in a premature neonate could be attributed to nefazodone exposure via breast milk. CASE SUMMARY The breast-fed white infant (female, 2.1 kg, 36 weeks corrected gestational age) of a 35-year-old woman (60 kg) taking nefazodone 300 mg/d was admitted to the hospital because she was drowsy, lethargic, unable to maintain normal body temperature, and was feeding poorly. A diagnosis of exposure to nefazodone via breast milk was considered only after other more likely diagnoses had been excluded. After breast feeding was discontinued, the infant's symptoms resolved slowly over a period of 72 hours. The maternal plasma and milk concentration-time profiles for nefazodone and its metabolites, triazoledione, HO-nefazodone, and m-chlorphenylpiperazine, were quantified by HPLC. The calculated infant dose for nefazodone and its active metabolites (as nefazodone equivalents) via the milk was only 0.45% of the weight-adjusted maternal nefazodone daily dose. DISCUSSION Our data suggest a putative association between maternal nefazodone ingestion and adverse effects in a premature breast-fed neonate. The measured amount of drug exposure would normally be considered safe in a full-term infant. However, there was a temporal relationship between resolution of adverse effects in the infant and cessation of breastfeeding. CONCLUSIONS This case highlights the importance of individualizing the risk-benefit analysis for exposure to antidepressants in breast milk, especially when dealing with premature neonates.
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Affiliation(s)
- P Yapp
- Pharmacy Department, King Edward Memorial Hospital, Subiaco, Western Australia.
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18
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Rampono J, Kristensen JH, Hackett LP, Paech M, Kohan R, Ilett KF. Citalopram and demethylcitalopram in human milk; distribution, excretion and effects in breast fed infants. Br J Clin Pharmacol 2000; 50:263-8. [PMID: 10971311 PMCID: PMC2014979 DOI: 10.1046/j.1365-2125.2000.00253.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AIMS To characterize milk/plasma (M/P) ratio and infant dose, for citalopram and demethylcitalopram, in breast-feeding women taking citalopram for the treatment of depression, and to determine the plasma concentration and effects of these drugs in their infants. METHODS Seven women (mean age 30.6 years) taking citalopram (median dose 0.36 mg kg(-1) day(-1)) and their infants (mean age 4.1 months) were studied. Citalopram and demethylcitalopram in plasma and milk were measured by high-performance liquid chromatography over a 24 h dose interval. Infant exposure was estimated (two separate methods) as the product of milk production rate and drug concentration in milk, normalized to body weight and expressed as a percentage of the weight-adjusted maternal dose. RESULTS Mean M/PAUC values of 1.8 (range 1.2-3) and 1.8 (range 1.0-2.5) were calculated for citalopram and demethylcitalopram, respectively. The mean maximum concentrations of citalopram and demethylcitalopram in milk were 154 (95% CI, 102-207) microg l(-1) and 50 (23-77) microg l(-1). Depending on the method of calculation, mean infant exposure was 3.2 or 3.7% for citalopram and 1.2 or 1.4% for demethylcitalopram. Citalopram (2.0, 2.3 and 2.3 microg l(-1)) was detected in three of the seven infants. Demethylcitalopram (2.2 and 2.2 microg l(-1) was detected in plasma from two of the same infants. No adverse effects were seen in the infants, all were within appropriate percentile limits for weight and all had normal Denver developmental quotients. CONCLUSIONS The mean combined dose of citalopram and demethylcitalopram (4.4-5.1% as citalopram equivalents) transmitted to infants via breast milk is below the 10% notional level of concern. Plasma concentrations of these drugs in the infants were very low or absent and there were no adverse effects. These data support the safety of the use of citalopram in breast feeding women. Nevertheless, each decision to breast feed should always be made as an individual risk:benefit analysis.
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Affiliation(s)
- J Rampono
- Department of Psychological Medicine, King Edward Memorial Hospital, Subiaco, Western Australia.
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Abstract
AIMS To characterize milk/plasma (M/P) ratio and infant dose, for fluoxetine and norfluoxetine, in breast-feeding women taking fluoxetine for the treatment of depression, and to determine the plasma concentration of these drugs in their infants. METHODS Fourteen women (mean age 32.2 years) taking fluoxetine (mean dose 0.51 mg kg-1 day-1 ) and their infants (mean age 3.4 months) were studied. Fluoxetine and norfluoxetine in plasma and milk were measured by high-performance liquid chromatography over a 24 h dose interval in four patients, and by single point data collection in 10 patients. Infant exposure was estimated as the product of estimated milk production, and average drug concentration in milk, normalized to body weight and expressed as a percentage of the weight-adjusted maternal dose. RESULTS Mean M/P values of 0.68 (95% CI 0.52-0.84) and 0.56 (95% CI 0.35-0.77) were calculated for fluoxetine and norfluoxetine, respectively. Mean total infant exposure (fluoxetine equivalents) was estimated to be 6.81% (range 2.15-12%) of the weight-adjusted maternal dose of fluoxetine. Contributions from fluoxetine and norfluoxetine were approximately equal. Fluoxetine (range 20-252 microgram l-1 ) was detected in five of the nine infants from whom samples were collected, and norfluoxetine (range 17-187 microgram l-1 ) was detected in seven of the nine infants. The highest of these concentrations was about 70% of the maternal plasma concentrations. CONCLUSIONS The mean combined dose of fluoxetine and norfluoxetine transmitted to infants via breast milk is below the 10% notional level of concern. However, there was considerable interpatient variability in estimated infant dose and in some of the patients, the dose was >10%. Further, since adverse effects have been observed in breast-fed infants, careful monitoring of the infants is mandatory. Neonates exposed to these drugs in utero had higher concentrations of fluoxetine and norfluoxetine and are at greater risk of adverse effects.
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Affiliation(s)
- J H Kristensen
- Department of Pharmacy, King Edward Memorial and Princess Margaret Hospitals, Subiaco, Western Australia.
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Abstract
Local and regional musculoskeletal discomfort and pain in the shoulder girdle or upper extremities are often reported, especially in the working population. In this review we describe the most important problems and factors when classifying musculotendinous pain in the upper extremities and shoulders. This includes an analysis of how four common diagnoses (wrist tenosynovitis, lateral epicondylitis, rotator-cuff tendinitis, myofascial pain syndrome) fulfil basic criteria of validity. It is evident that there are some serious problems regarding the validity of the current classification of the conditions. Clinical criteria are often poorly defined and the reliability insufficiently tested. The relationship to objective pathoanatomic or physiological findings seems inconsistent. Although magnetic resonance and ultrasonographic imaging are promising, they are still only preliminary methods for evaluation of tendon and connective tissue structures. The prognosis with and without treatment also seems heterogeneous and can vary between studies. A generally accepted terminology is lacking in the pathogenetically complex regional muscle pain conditions.
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Affiliation(s)
- J Nørregaard
- Department of Work Physiology and Ergonomics, Danish Institute of Occupational Health, Bispebjerg Hospital, Copenhagen
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Abstract
New methods for optimum separation of (2)H MAS NMR spectra are presented. The approach is based on hypercomplex spectroscopy that is useful for sign discrimination and phase separation. A new theoretical formalism is developed for the description of hypercomplex experiments. This exploits the properties of Lie algebras and hypercomplex numbers to obtain a solution to the Liouville-von Neumann equation. The solution is expressed in terms of coherence transfer functions that describe the allowed coherence transfer pathways in the system. The theoretical formalism is essential in order to understand all the features of hypercomplex experiments. The method is applied to the development of two-dimensional quadrupole-resolved (2)H MAS NMR spectroscopy. The important features of this technique are discussed and two different versions are presented with widely different characteristics. An improved version of two-dimensional double-quantum (2)H MAS NMR spectroscopy is developed. The conditions under which the double-quantum experiment is useful are discussed and its performance is compared with that observed for the quadrupole-resolved experiments. A general method is presented for evaluating the optimum pulse sequence parameters consistent with maximum sensitivity and resolution. This approach improves the performance of the experiments and is essential for any further development of the techniques. The effects of finite pulse width and hypercomplex data processing may lead to both intensity and phase distortions in the spectra. These effects are analyzed and general correction procedures are suggested. The techniques are applied to polycrystalline malonic-acid-(2)H(4) for which the spinning sideband manifolds from the carboxyl and methylene deuterons are separated. The spinning sideband manifolds are simulated to determine the quadrupole parameters. The values are consistent with previous results, indicating that the techniques are both accurate and reliable.
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Affiliation(s)
- J H Kristensen
- Department of Chemistry, University of Aarhus, Aarhus C, DK-8000, Denmark
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Abstract
AIM To determine the effect of cisapride on gastrointestinal motility in preterm infants. METHODS Cisapride (0.2 mg/kg, 8 hourly ) or placebo was given first for seven days in a double blind randomised crossover study of 10 preterm infants. Gastrointestinal motility was assessed on day 3 of each treatment. The half gastric emptying time (GET1/2) was determined by using ultrasonography to measure the decrease in the gastric antral cross sectional area after a feed. The whole gastrointestinal transit time (WGTT) was assessed by timing the transit of carmine red through the gut. Treatments were compared using the Wilcoxon matched pairs signed ranks test. RESULTS Median (range) birthweight was 1200 (620, 1450) g and postconceptional age 33 (29, 34) weeks at recruitment. GET1/2 was significantly longer during cisapride treatment than during placebo; the median of the differences (95% confidence interval) was 19.2 (11, 30 minutes, p=0.008). WGTT was also longer during cisapride treatment, but the difference was not significant; the median of the differences was 11(-18, 52 hours, p=0.1). CONCLUSIONS Cisapride delays gastric emptying and may delay WGTT in preterm infants. Its use to promote gastrointestinal motility in this group cannot be recommended.
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Affiliation(s)
- R J McClure
- Department of Newborn Services, King Edward Memorial Hospital, Perth, Western Australia
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Abstract
The Dade Behring N Latex Cystatin C assay, a particle-enhanced nephelometric immunoassay for measuring serum cystatin C, was evaluated on the Dade Behring Nephelometer II. The assay time was 6 min and the throughput was 75 samples per hour. The sample volume was 40 microL and the measuring range was 0.25-7.90 mg/L. Imprecision studies revealed within-run CVs < 1.8% and between-run CVs < 1.8% in the concentration range 0.87-4.63 mg/L. Recovery was 92.4-101.3%. Linearity studies showed excellent correlation between the theoretical and obtained values. No interferences were detected from haemoglobin < 1.0 mmol/ L, bilirubin <512 micromol/L and Intralipid <20 g/L. Stability of cystatin C in serum was 7 days at temperatures from 20 degrees C to 20 degrees C and 6 months at -80 degrees C. Measurements of cystatin C in heparin-plasma and EDTA-plasma did not differ significantly from cystatin C measured in serum. Fifty patient samples run on the Dade Behring Nephelometer II (y) were compared to the Dako Cystatin C assay (x). The Passing-Bablok regression analysis revealed y = 1.105x - 0.340. In conclusion, the Dade Behring N Latex Cystatin C assay was precise and correlated with the Dako Cystatin C assay.
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Affiliation(s)
- E J Erlandsen
- Department of Clinical Biochemistry, Viborg County Hospital, Denmark.
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Abstract
The protease inhibitor cystatin C is a non-glycosylated low molecular weight protein (Mr=13359) which is produced by all nucleated cells at a constant rate, freely filtered by the renal glomeruli, and catabolized in the tubuli. The aim of the study was to elucidate the applicability of serum cystatin C as a marker of glomerular filtration rate (GFR) in patients with various kidney diseases with a wide range of renal function and in dialysis patients. Seventy-six patients with various kidney diseases (aged 20 to 79 years) and 61 dialysis patients (aged 21 to 82 years) were included. Serum cystatin C was measured by automated particle-enhanced immunoturbidimetry, serum and urine creatinine by an enzymatic method, and GFR by 99mTc-DTPA-clearance using a single plasma sample method. Serum cystatin C in patients with various kidney diseases was 1.90+/-0.98 mg/L (mean+/-SD) and in dialysis patients 7.14+/-1.91 mg/L. In the non-dialysis patients a linear relationship was found between 99mTc-DTPA-clearance and 1/serum cystatin C (r=0.91, p-value<0.0001), 1/serum creatinine (r=0.89, p-value<0.0001), and creatinine-clearance (r=0.88, p-value<0.0001). Comparison of the non-parametric ROC plots for serum cystatin C (area under the curve (AUC)=0.9665; SE=0.0169), serum creatinine (AUC=0.9554; SE=0.0205), and creatinine-clearance (AUC=0.9731; SE=0.0160) revealed no significant differences (p-values: 0.50, 0.78, and 0.49). In conclusion, cystatin C may be a likewise good marker of the GFR as serum creatinine and creatinine-clearance, cystatin C having the advantage being independent of gender and muscle mass.
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Affiliation(s)
- E Randers
- Department of Internal Medicine, Viborg County Hospital, Denmark.
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Abstract
The technique of 2H MAS NMR spectroscopy is presented for the investigation of multiaxial molecular dynamics. To evaluate the effects of discrete random reorientation a Lie algebraic formalism based on the stochastic Liouville-von Neumann equation is developed. The solution to the stochastic Liouville-von Neumann equation is obtained both in the presence and absence of rf irradiation. This allows effects of molecular dynamics to be evaluated during rf pulses and extends the applicability of the formalism to arbitrary multiple pulse experiments. Theoretical methods are presented for the description of multiaxial dynamics with particular emphasis on the application of vector parameters to represent molecular rotations. Numerical time and powder integration algorithms are presented that are both efficient and easy to implement computationally. The applicability of 2H MAS NMR spectroscopy for investigating molecular dynamics is evaluated from theoretical spectra. To demonstrate the potential of the technique the dynamics of thiourea-2H4 is investigated experimentally. From a series of variable temperature MAS and quadrupole echo spectra it has been found that the dynamics can be described by composite rotation about the CS and CN bonds. Both experiments are sensitive to the fast CS rotation which is shown to be described by the Arrhenius parameters E(CS) = 46.4 +/- 2.3 kJ mol(-1) and ln(A(CS))= 32.6 +/- 0.9. The MAS experiment represents a significant improvement by simultaneously allowing the dynamics of the slow CN rotation to be fully characterized in terms of E(CN) = 56.3 +/- 3.4 kJ mol(-1) and ln(A(CN)) = 25.3 +/- 1.1.
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Affiliation(s)
- J H Kristensen
- Department of Physics, College of William and Mary, Williamsburg, VA 23187-8795, USA
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Hagelskjaer LH, Prag J, Malczynski J, Kristensen JH. Incidence and clinical epidemiology of necrobacillosis, including Lemierre's syndrome, in Denmark 1990-1995. Eur J Clin Microbiol Infect Dis 1998; 17:561-5. [PMID: 9796654 DOI: 10.1007/bf01708619] [Citation(s) in RCA: 183] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To establish the incidence and describe the clinical epidemiology of necrobacillosis and Lemierre's syndrome in Denmark, the clinical records of all laboratory-recorded cases of septicaemia due to Fusobacterium necrophorum biovar A, B, and C were reviewed retrospectively during a 6-year period. The incidence of necrobacillosis and Lemierre's syndrome was 1.5 and 0.8 per million persons per year, respectively, showing a tendency to increase during the period. Fusobacterium necrophorum was grown after three days' incubation, but the characteristic pleomorphic fusiform morphology was often disregarded as an important help in diagnosing necrobacillosis. The 24 patients with Lemierre's syndrome were all young and previously healthy, and none died, but pre-hospital delay was associated with a significantly higher morbidity and risk of metastatic infections. The remaining 25 patients with necrobacillosis had a high mortality, 24%, which was correlated with age and predisposing diseases, especially cancers. These findings stress the importance of a quicker clinical and microbiological diagnosis in cases of Lemierre's syndrome, and of screening for cancer in the remaining cases of necrobacillosis.
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Affiliation(s)
- L H Hagelskjaer
- Department of Clinical Microbiology, Viborg Hospital, Denmark
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27
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Abstract
The aim of this study was to establish reference intervals for cerum cystatin C and serum creatinine in adults. Blood samples were collected from 270 healthy blood donors (135 men and 135 women between 20 and 65 years old with 15 men and 15 women in each five-year-interval). Serum cystatin C was analyzed using an automated particle-enhanced immunoassay (DAKO Cystatin C PET kit) on the Cobas Mira S analyzer. Serum creatinine was analyzed using the Vitros Creatinine Slide, an enzymatic method on the Vitros 950 chemistry analyzer. The calculated reference intervals for serum cystatin C were 0.62-1.15 mg/l in women (median 0.84 mg/l, range 0.56-1.29 mg/l) and 0.51-1.25 mg/l in men (median 0.87 mg/l, range 0.42-1.39 mg/l). The Mann-Whithey U-test revealed no gender-related difference for cystatin C (p = 0.48). A common reference interval in women and men was calculated to be 0.54-1.21 mg/l (median 0.85 mg/l, range 0.42-1.39 mg/l). The non-parametric reference interval for serum creatinine was 57-95 mumol/l in women (median 72 mumol/l, range 44-105 mumol/l) and 69-111 mumol/l in men (median 89 mumol/l, range 58-123 mumol/l).
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Affiliation(s)
- E J Erlandsen
- Department of Clinical Biochemistry, Viborg County Hospital, Denmark.
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Ilett KF, Hackett LP, Dusci LJ, Roberts MJ, Kristensen JH, Paech M, Groves A, Yapp P. Distribution and excretion of venlafaxine and O-desmethylvenlafaxine in human milk. Br J Clin Pharmacol 1998; 45:459-62. [PMID: 9643618 PMCID: PMC1873542 DOI: 10.1046/j.1365-2125.1998.00710.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AIMS To characterise the transfer of venlafaxine (V) and its O-desmethyl metabolite (ODV) into human milk by measuring milk/plasma (M/P) ratio, and to estimate the likely dose received by a breast-fed infant. METHODS Milk and plasma samples were collected from three lactating women who were taking venlafaxine for depression, and were at steady-state. In two of the patients, venous blood and milk samples were collected 0, 1, 2, 3, 4, 6, 8 and 12 h post dose, while in the third patient a single pair of blood and milk samples was obtained 0.83 h post dose. A plasma sample was obtained from each of their infants. V and ODV were measured in plasma and milk by high performance liquid chromatography. M/P was calculated and infant dose estimated as drug concentration in milk x a milk intake of 0.15 l kg(-1) day(-1), relative to the weight-adjusted maternal dose. RESULTS Mean M/P for V was 4.1 (range 2.8-4.8) and 3.1 for ODV (range 2.8-3.8). The mean total infant dose (as V equivalents) was 7.6% (range 4.7-9.2%) of the maternal weight-adjusted dose, with approximately equal amounts of V (3.5%) and ODV (4.1%) in the dose. ODV (median 100 microg I(-1)) was detected in the plasma of all three infants. The infants were healthy and showed no acute adverse effects. CONCLUSIONS These preliminary data show that the total dose of V and ODV ingested by breast-fed infants can be as high as 9.2% of maternal intake. Moreover there were measurable concentrations of ODV in the infants' plasma. We recommend that exposed infants should be observed closely.
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Affiliation(s)
- K F Ilett
- Department of Pharmacology, University of Western Australia, Nedlands
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Kristensen JH, Ilett KF, Dusci LJ, Hackett LP, Yapp P, Wojnar-Horton RE, Roberts MJ, Paech M. Distribution and excretion of sertraline and N-desmethylsertraline in human milk. Br J Clin Pharmacol 1998; 45:453-7. [PMID: 9643617 PMCID: PMC1873544 DOI: 10.1046/j.1365-2125.1998.00705.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AIMS To characterise milk/plasma (M/P) ratio and infant exposure, for sertraline and N-desmethylsertraline, in breast-feeding women taking sertraline for the treatment of depression. METHODS Eight women (mean age 28 years) taking sertraline (1.05 mg kg(-1) day(-1)) and their infants (mean age 5.7 months) were studied. Sertraline and N-desmethylsertraline in plasma and milk were measured by high-performance liquid chromatography over a 24 h dose interval at steady-state. M/P values were estimated from area under the plasma and milk concentration-time curves. All milk produced was collected over the dose interval. Infant exposure was estimated as the product of actual or estimated milk production, and average drug concentration in milk, normalized to body weight and expressed as a percentage of the weight-adjusted maternal dose. RESULTS Mean milk production was 321 ml day(-1) (range 34-974 ml). Mean M/P values of 1.93 and 1.64 were calculated for sertraline and N-desmethylsertraline respectively. Infant exposure estimated from actual milk produced was 0.2% and 0.3% of the weight-adjusted maternal dose for sertraline and N-desmethylsertraline (as sertraline equivalents) respectively. When calculated from estimated milk production (0.15 l kg(-1) day(-1)), infant exposure was significantly greater (P<0.0001) at 0.90% and 1.32% for sertraline and N-desmethylsertraline respectively. Neither sertraline nor its N-desmethyl metabolite could be detected in plasma samples from the four infants tested. No adverse effects were observed in any of the eight infants and all had achieved normal developmental milestones. CONCLUSIONS Irrespective of the method of calculation of infant exposure, the mean total dose of sertraline and its N-desmethyl metabolite transmitted to infants via breast-feeding is low and unlikely to cause any significant adverse effects.
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Affiliation(s)
- J H Kristensen
- Department of Pharmacy, King Edward Memorial Hospital, Subiaco, Western Australia
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Abstract
Postoperative nausea and vomiting (PONV) is still an important and common problem. Despite the introduction of new antiemetic drugs, the management of PONV remains difficult. In this article we describe the development and evaluation of a management protocol for PONV, which consists of a treatment algorithm accompanied by a nursing education program. Implementation of this management protocol has been well-accepted by staff, appears to have reduced delay in patient treatment and improved patient care, and has significantly reduced staff workload. It is planned to use continuous quality improvement techniques to further refine the algorithm and continue assessment of its efficacy and of patient satisfaction.
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Affiliation(s)
- M J Paech
- Department of Anaesthesia, King Edward Memorial Hospital for Women, Perth, Western Australia
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Wojnar-Horton RE, Kristensen JH, Yapp P, Ilett KF, Dusci LJ, Hackett LP. Methadone distribution and excretion into breast milk of clients in a methadone maintenance programme. Br J Clin Pharmacol 1997; 44:543-7. [PMID: 9431829 PMCID: PMC2042880 DOI: 10.1046/j.1365-2125.1997.t01-1-00624.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIMS Methadone is widely used in maintenance programs for opioid-dependent subjects. The aims of the study were to quantify the distribution and excretion of methadone in human milk during the early postnatal period and to investigate exposure of breast fed infants to the drug. METHODS Blood and milk samples were obtained from 12 breast feeding women who were taking methadone in daily doses ranging from 20-80 mg (0.3-1.14 mg kg-1). Blood was also obtained from eight of their infants. Methadone concentration in these samples was quantified by h.p.l.c. The infants were observed for withdrawal symptoms. RESULTS The mean (95% CI) milk/plasma ratio was 0.44 (0.24-0.64). Exposure of the infants, calculated assuming an average milk intake of 0.15 l kg-1 day-1 and a bioavailability of 100% was 17.4 (10.8-24) microg kg-1 day-1. The mean infant dose expressed as a percentage of the maternal dose was 2.79 (2.07-3.51)%. Methadone concentrations in seven infants were below the limit of detection for the h.p.l.c. assay procedure, while one infant had a plasma methadone concentration of 6.5 microg l-1. Infant exposure to methadone via human milk was insufficient to prevent the development of a neonatal abstinence syndrome which was seen in seven (64%) infants. No adverse effects attributable to methadone in milk were seen. CONCLUSIONS We conclude that exposure of breast fed infants to methadone taken by their mothers is minimal and that women in methadone maintenance programs should not be discouraged from breast feeding because of this exposure.
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Affiliation(s)
- R E Wojnar-Horton
- Department of Pharmacy, Fremantle Hospital and Health Service, Western Australia
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32
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Kristensen JH, Hagelskjaer LH, Prag J. Erythema multiforme major in a female with acute systemic meningococcal disease. Acta Derm Venereol 1997; 77:484. [PMID: 9394992 DOI: 10.2340/0001555577484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Nielsen HB, Secher NH, Kristensen JH, Christensen NJ, Espersen K, Pedersen BK. Splenectomy impairs lymphocytosis during maximal exercise. Am J Physiol 1997; 272:R1847-52. [PMID: 9227599 DOI: 10.1152/ajpregu.1997.272.6.r1847] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To evaluate the role of the spleen for the exercise-induced lymphocytosis, six splenectomized subjects and six matched control subjects cycled for 12 min at two submaximal work rates corresponding to 50 and 75% of their maximal work capacity, followed by a supramaximal intensity maintained until exhaustion (16 +/- 1 min; mean +/- SE). Venous blood samples were taken before, during, and 2 h after the maximal load. In both groups, the concentration of lymphocytes became elevated during exercise, but the increase from the level at rest was impaired in the splenectomized subjects compared with that of the controls (118 +/- 34 vs. 238 +/- 38%; P < 0.05). This was reflected in several lymphocyte subsets: cluster designation (CD) 3+ cells (pan T lymphocytes), 69 +/- 19 vs. 204 +/- 37%; CD8+ cells (T lymphocyte subset), 164 +/- 41 vs. 467 +/- 68%; CD16+ cells [natural killer (NK) cells], 291 +/- 88 vs. 870 +/- 177%; CD56+ cells (NK cells), 301 +/- 108 vs. 753 +/- 187%. Also, the specific NK cell lysis of target cells (NK cell activity) during exercise was lower for the splenectomized subjects (30 +/- 7%) than that of the control subjects (52 +/- 10%), but evaluation of lytic units indicates that this was due to a reduced number of NK cells in the assay rather than insufficient cell lysis. Plasma catecholamines reached the same level in the splenectomized subjects and control subjects, which was taken to reflect that the activity of the sympathetic nervous system was similar in the two groups of subjects. Thus the major finding of this study is that the spleen is important for lymphocytosis during exercise, accounting for two-thirds of the increase in T lymphocytes and NK cells.
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Affiliation(s)
- H B Nielsen
- Copenhagen Muscle Research Center, Department of Infectious Diseases, Rigshospitalet, Denmark
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Engelhart M, Kondrup J, Høie LH, Andersen V, Kristensen JH, Heitmann BL. Weight reduction in obese patients with rheumatoid arthritis, with preservation of body cell mass and improvement of physical fitness. Clin Exp Rheumatol 1996; 14:289-93. [PMID: 8809443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To reduce body weight in obese patients with rheumatoid arthritis (RA) without loss of body cell mass (BCM) and without impairment of physical performance. METHODS Nineteen overweight RA patients were studied before, during, and after a 12-week weight reducing regime consisting of reduced dietary energy intake, supplemented with a high-protein-low-energy powder preparation, and moderate physical training. Body composition was measured by a four compartment method, which by combining determinations of total body water and total body potassium allows a distinction between the two variable components of fat free mass (FFM): BCM and extracellular water (ECW). Physical fitness was measured by a bicycle exercise test. RESULTS Mean weight loss during the study was 4.5 kg. The patients lost 9% of their initial fat mass, 3% of initial BCM and 5% of initial ECW. Physical fitness was slightly, but significantly, improved. CONCLUSION The regime described was successful in achieving a significant weight loss with minimal loss of BCM and maintenance of physical fitness.
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Affiliation(s)
- M Engelhart
- Department of Medicine TA, Section of Rheumatology, Rigshospitalet, Copenhagen, Denmark
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35
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Rannem T, Ladefoged K, Hylander E, Christiansen J, Laursen H, Kristensen JH, Linstow M, Beyer N, Liguori R, Dige-Petersen H. The effect of selenium supplementation on skeletal and cardiac muscle in selenium-depleted patients. JPEN J Parenter Enteral Nutr 1995; 19:351-5. [PMID: 8577010 DOI: 10.1177/0148607195019005351] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The purpose of the present study was to evaluate the effect of sodium selenite on skeletal and cardiac muscular function in patients with severe Se deficiency. METHODS Skeletal and cardiac muscular function was investigated in 10 selenium depleted patients on long-term home parenteral nutrition because of short bowel syndrome. The following examinations were applied: Skeletal muscle biopsy, muscular force test (Kin-Com dynamometer test), electromyography (EMG) and radionuclide ventriculography. The patients were blindly randomized to intravenous supplementation with selenium 200 micrograms 5 to 7 times per week or placebo for 4 months. Hereafter the examinations were repeated. The patients randomized to placebo received selenium in an open study for a further 4 months and hereafter their skeletal and cardiac function was reevaluated. RESULTS Plasma selenium increased to normal levels from median .21 mumol/l (range 0-.69) to 1.25 mumol/l (range .9-2.27) following selenium repletion. The muscle biopsies showed only minor abnormalities. The only change after selenium supplementation was a small but statistically significant increase of the mean diameter of fiber type 1. The muscle strength of the quadriceps muscle was unchanged after selenium substitution. EMG did not reveal signs of myopathy. The cardiac function was normal and remained unchanged. CONCLUSION Despite severe selenium depletion ten patients on long term home parenteral nutrition had normal cardiac function, and no clinically significant signs of skeletal myopathy. The only change after selenium supplementation was a small but statistically significant increase of the mean diameter of muscle fiber type 1.
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Affiliation(s)
- T Rannem
- Department of Gastroenterology, Rigshospitalet, Copenhagen, Denmark
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36
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Rohde T, Ullum H, Rasmussen JP, Kristensen JH, Newsholme E, Pedersen BK. Effects of glutamine on the immune system: influence of muscular exercise and HIV infection. J Appl Physiol (1985) 1995; 79:146-50. [PMID: 7559212 DOI: 10.1152/jappl.1995.79.1.146] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Glutamine increased the proliferative response and the lymphokine-activated killer cell activity of blood mononuclear cells isolated from normal healthy subjects (n = 6) in a dose-dependent manner, with optimum at 0.3-1.0 mM. The relative fraction of CD3+, CD4+, CD8+, CD14+, CD16+, and CD19+ cells was not changed by glutamine at a concentration of 0.6 mM, except in the phytohemagglutinin-stimulated proliferation experiment where the fraction of CD4+, and therefore CD3+ cells, increased. The natural killer cell activity was not influenced by glutamine. Human immunodeficiency virus (HIV)-seropositive subjects (n = 8) who performed concentric bicycle exercise for 1 h at 75% of maximal O2 consumption had an overall lower phytohemagglutinin-stimulated proliferative response, compared with the HIV-seronegative control group (n = 7). The proliferation during exercise was lower in both the HIV-seropositive and the HIV-seronegative group. Addition of glutamine in vitro did not normalize the lower proliferation in the HIV-seropositive group or the attenuated proliferation seen during exercise in both groups.
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Affiliation(s)
- T Rohde
- Laboratory of Infectious Diseases, Copenhagen Muscle Research Centre, Rigshospitalet, Denmark
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37
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Heitmann BL, Kondrup J, Engelhart M, Kristensen JH, Pødenphant J, Høie H, Andersen V. Changes in fat free mass in overweight patients with rheumatoid arthritis on a weight reducing regimen. A comparison of eight different body composition methods. Int J Obes Relat Metab Disord 1994; 18:812-9. [PMID: 7894520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The aim of this work was to compare and validate seven different methods for estimating changes in fat free mass, in patients suffering from rheumatoid arthritis. Measurements were made of fat and fat free mass before and after 12 weeks on an energy restricted, protein rich diet and physical training. The subjects were sixteen female and three male overweight out-patients (mean body mass index at baseline: 30 kg/m2) suffering from rheumatoid arthritis, according to the criteria of the American Rheumatism Association. Fat free mass was estimated by eight different body composition methods (a four-compartment model, total body water, total body potassium, impedance, near infrared interactance, creatinine excretion, body mass index and skinfold measurements). Mean weight loss was 2.7 kg fat and 1.7 kg fat free mass. There was no difference between measurements of mean change in fat free mass by the four-compartment model and the other methods, except for the creatinine method (P = 0.03). Compared to the four-compartment method, the total body water method gave the most accurate estimate of individual fat free mass changes (residual Mean Square: 0.4 kg), second to this method, the impedance method, seemed most valid (residual Mean Square: 0.8 kg). Accuracies of the other methods were lower (residual Mean Square between 4.2 and 8.2 kg [corrected]). Of eight methods for estimating changes in FFM, the TBW method gave the most accurate estimate of individual FFM changes, compared to a four-compartment model used as reference.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- B L Heitmann
- Institute of Preventive Medicine, Copenhagen Health Services, Municipal Hospital of Copenhagen, Denmark
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38
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Kristensen JH. [AIDS--need for knowledge of psychiatric nursing. Interview by Lars Peter Bergqvist]. Sygeplejersken 1993; 93:8-10. [PMID: 8322217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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39
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Hansen FR, Bendix T, Skov P, Jensen CV, Kristensen JH, Krohn L, Schioeler H. Intensive, dynamic back-muscle exercises, conventional physiotherapy, or placebo-control treatment of low-back pain. A randomized, observer-blind trial. Spine (Phila Pa 1976) 1993; 18:98-108. [PMID: 8434332 DOI: 10.1097/00007632-199301000-00015] [Citation(s) in RCA: 152] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In a randomized, observer-blind trial, 150 men and women, aged 21-64 years, with chronic/subchronic low-back pain, followed one of these three treatment regimens: 1) intensive, dynamic back-muscle exercises; 2) conventional physiotherapy, including isometric exercises for the trunk and leg muscles; and 3) placebo-control treatment involving semihot packs and light traction. Eight treatment sessions were given during the course of 4 weeks, each session lasting 1 hour. The short-term effect was evaluated at the end of the treatment period and 1 month later, and the long-term effect at 6 and 12 months. The evaluations included recording of changes in pain level and assessment of overall treatment effect, which were indicated on visual interval scales. Subgroups of patients could be identified according to their treatment responses: physiotherapy was the superior treatment for the male participants, whereas the intensive back exercises appeared to be most efficient for the female participants. Patients with moderate or hard physical occupations tended toward a better response with physiotherapy, whereas intensive back exercises seemed most effective for those with sedentary/light job functions.
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Affiliation(s)
- F R Hansen
- Medical Department, State University Hospital, Copenhagen, Denmark
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Kristensen JH. [AIDS. Important to keep a cool head and a warm heart]. Sygeplejersken 1987; 87:22-6. [PMID: 3686392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Jans H, Heltberg A, Zeeberg I, Kristensen JH, Fog T, Raun NE. Immune complexes and the complement factors C4 and C3 in cerebrospinal fluid and serum from patients with chronic progressive multiple sclerosis. Acta Neurol Scand 1984; 69:34-8. [PMID: 6702418 DOI: 10.1111/j.1600-0404.1984.tb07777.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Immune complexes (IC) have been found in both serum and cerebrospinal fluid (CSF) in multiple sclerosis (MS). The complement system is known to play a major role as a mediator of inflammation in immune complex disease. Therefore, we have investigated paired samples of serum and CSF from 32 patients with progressive MS for IC, the levels of the complement factors C4 and C3, and presence of their activation products (AP). IC was found in serum from 17 of the 32 MS patients (53%) and in CSF from 9 of 31 MS patients (29%). No correlation was found between the occurrence of IC in serum and in CSF. The levels of C3 in serum and CSF from the MS patients did not differ from the levels in a control group, whereas the levels of C4 in MS-serum were elevated and the C4 levels in MS-CSF reduced. A low level of CSF-C4 correlated significantly to the occurrence of CSF-IC. AP of C4 and C3 in serum were seen in 11 of the 32 patients (34%), appearing significantly more frequently among patients with circulating IC. No C4- or C3AP could be identified in CSF.
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Petersen FB, Siggaard-Andersen J, Kristensen JH, Kjeldsen K. Capillary filtration rate on the human calf during exposure to carbon monoxide and hypoxia (3454m). Scand J Clin Lab Invest Suppl 1968; 103:49-54. [PMID: 5720768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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