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PP 7.8 – 00060 Slowing or Reversal of Decay of Intact Proviruses Over Two Decades of Suppressive ART. J Virus Erad 2022. [DOI: 10.1016/j.jve.2022.100270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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[Meralgia paraesthetica as complication of patient positioning : A not fully controllable risk]. DIE ANAESTHESIOLOGIE 2022; 71:858-864. [PMID: 36282281 PMCID: PMC9592874 DOI: 10.1007/s00101-022-01213-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
Als Meralgia paraesthetica (MP) bezeichnet man eine zu den neurologischen Engpasssyndromen zählende Schädigung des aus dem Plexus lumbalis entspringenden sensiblen N. cutaneus femoris lateralis. Symptome sind temporäre oder bleibende Parästhesien und Schmerzen an der Vorder- und Außenseite des Oberschenkels. Die MP kann idiopathisch auftreten, sich genuin als z. B. „seat belt syndrome“ oder „Jeans-Syndrom“ verwirklichen, sie kann aber auch Folge eines operativen Eingriffs oder einer chirurgischen bzw. intensivmedizinischen Lagerung sein. Im Fokus stehen hierbei in der Literatur die Steinschnitt-, die Bauch- und die „Beach-chair“-Lagerung. Analysiert wurden 21 Beschwerden über eine postoperativ erstmals aufgetretene MP, die bei der Gutachterkommission für ärztliche Behandlungsfehler bei der Ärztekammer Nordrhein im Verlauf der letzten 10 Jahre eingereicht wurden. Unter diesen konnten 6 Fälle als Lagerungsschaden nach Steinschnittlagerung identifiziert werden; in 3 Fällen trat eine MP nach Rückenlagerung auf; die Ätiologie konnte nicht sicher geklärt werden. In 12 Fällen wurde die MP als direkte Operationskomplikation erkannt. Pathophysiologie, Inzidenz und Verlauf sowie juristische Implikationen der lagerungsbedingten MP werden beschrieben. Als hauptsächlicher Pathomechanismus wird eine Druckschädigung des Nervs an seiner Kreuzungsstelle mit dem Leistenband diskutiert. Wenngleich alle hier vorgestellten Fälle nach der Steinschnittlagerung auftraten, scheint sich die Komplikation nach Literaturdaten auch bei anderen Lagerungsarten, am häufigsten möglicherweise bei Bauchlagerungen, zu verwirklichen. Dies erklärt auch die zunehmenden Fallberichte einer MP nach Bauchlagerung bei COVID-19-Patient*innen. Eine sichere Vermeidung der lagerungsbedingten Komplikation erscheint aufgrund der anatomischen Variabilität des Nervenverlaufs und der unklaren Pathomechanismen nicht möglich.
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Implementation and scalability of a digital intervention to reduce depressive symptoms in people with diabetes, hypertension or both in Brazil and Peru: a qualitative study of health system's stakeholders' perspectives. DISCOVER MENTAL HEALTH 2022; 2:12. [PMID: 35677652 PMCID: PMC9163924 DOI: 10.1007/s44192-022-00015-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/17/2022] [Indexed: 12/20/2022]
Abstract
Two randomized controlled trials (RCTs) in Brazil and Peru demonstrated the effectiveness of CONEMO, a digital intervention supported by trained nurses or nurse assistants (NAs), to reduce depressive symptoms in people with diabetes and/or hypertension. This paper extends the RCTs findings by reflecting on the conditions needed for its wider implementation in routine care services. A qualitative study using semi-structured interviews and content analysis was conducted with nurses/NAs, clinicians, healthcare administrators, and policymakers. Informants reported that CONEMO would be feasible to implement in their health services, but some conditions could be improved before its scale-up: reducing workloads of healthcare workers; raising mental health awareness among clinicians and administrators; being able to inform, deliver and accompany the intervention; assuring appropriate training and supervision of nurses/NAs; and supporting the use of technology in public health services and by patients, especially older ones. We discuss some suggestions on how to overcome these challenges.
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Association with severe and treatment-resistant depression among patients with inflammatory joint disease. Nationwide nested case-control study in Swedish registers. Eur Psychiatry 2022. [PMCID: PMC9564964 DOI: 10.1192/j.eurpsy.2022.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction Treatment resistant depression (TRD) and severe depression (SD) are common among patients with depression. Patients with inflammatory joint disease (IJD) are at higher risk for developing depression compared to the general population; however, the risk for SD or TRD is not known. Objectives
To examine the odds of patients with IJD for developing SD and TRD compared to non-severe and non-TRD depression. Methods This case-control study was nested within a cohort of patients with incident depression (n=443,384) identified in nationwide Swedish registers 2006-2018. Patients with SD (n=42,975) were identified through the ICD-10 code specifier, through psychiatric hospitalization and/or through suicide attempts. Patients who started a third consecutive treatment for depression were identified with TRD (n=33,830). Each patient was matched with five non-SD - or non-TRD - patients by sociodemographics and year of cohort entry. Crude and adjusted odds ratios (aOR) were calculated by conditional logistic regression with regard to a history of any IJD and specific IJDs prior to depression onset. Results Among patients with depression, those with a history of IJD did not have higher odds for developing SD (aOR 1.09 (95%CI 1.00-1.20)) or TRD (aOR 1.03 (0.93 - 1.14)) compared to patients without IJD. A history of rheumatoid arthritis was associated with a significantly higher odds for SD among patients aged 18-29 (aOR 1.55 (1.01-2.36)) and for TRD among patients aged 30-49 (aOR 1.33 (1.05-1.67). Conclusions Overall, no association was observed between history of IJD and developing SD/TRD; with the exception of younger age strata in rheumatoid arthritis. Disclosure PB, JA, DH, LB, and JR are affiliated to or employees at The Unit for Clinical Epidemiology, Karolinska Institutet, which receives grants from several entities (pharmaceutical companies, regulatory authorities, contract research organizations) for the per
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[Thalamic infarction following paradoxical embolism during total hip replacement : Case report and pathophysiological considerations]. Anaesthesist 2022; 71:535-540. [PMID: 35133444 DOI: 10.1007/s00101-022-01094-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/14/2022] [Indexed: 11/24/2022]
Abstract
Because of a painful right-sided coxarthrosis a 57-year-old female patient underwent a cementless total arthroplasty under general anesthesia. Except for Asperger's syndrome and an occlusion of a vein in her left eye she stated no other diseases or complaints, especially no cardiac problems. Postoperatively she developed neurological symptoms of left-sided hemiparesis and hemihypesthesia. A cranial computer tomography was performed and a right-sided infarction of the thalamic region was found. A patent foramen ovale (PFO) and atrial septal aneurysm were detected 5 days later. The incidence of a PFO is given as 25% of the population. A paradoxical air embolism in the presence of a PFO is a feared complication in neurosurgical interventions in a semi-sitting or sitting position. Corpuscular emboli, such as bone, cement, fat or wound debris may be the reason for paradoxical embolisms in combination especially with partial or total hip replacement. The kind of embolism in the case described could not be clarified. Deep vein thrombosis or cardiac arrhythmia could be excluded. Therefore, it can be considered most likely that the operation site was the source of the embolism. The trigger for a paradoxical embolism is a reversal of the pressure difference between the right and left atria: normally the left atrial pressure exceeds the right atrial pressure by ca. 2-4 mm Hg, resulting possibly in a small clinically irrelevant left-to-right shunt. If the pulmonary arterial circulation is compromised and pulmonary vascular resistance increases, the pressure gradient between the left and right atria reverses and a right-to-left shunt can occur causing a paradoxical embolism. Positive end-expiratory pressure (PEEP) ventilation during anesthesia could be an important reason for a shunt reversal between the right and left atria and therefore favoring a paradoxical embolism but the pathophysiological role of PEEP has not yet been finally clarified.
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OP0185 RADIOGRAPHIC PROGRESSION DESPITE PERSISTENT LDA OR REMISSION IS INFLUENCED BY CURRENT SMOKING RATHER THAN THE RESPECTIVE DAS 28 LEVEL, RESULTS OF THE SWISS RHEUMATOID ARTHRITIS REGISTER (SCQM). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The therapeutic aim for rheumatoid arthritis (RA) is to control disease activity and prevent radiographic progression. Various clinical scores are utilized to describe disease activity in RA patients. The DAS28 score can define states of low disease activity (LDA) and remission. Despite achieving LDA or remission, radiographic progression may nevertheless occur. However, the rates and frequency of this occurrence have not been analyzed in detail.Objectives:To describe the frequency and rate of radiographic progression in patients with persistent LDA or remission.Methods:Analysis of RA patients from the SCQM cohort. Persistent LDA or remission were defined as DAS 28 ≤3.2 or <2.6 respectively, at two subsequent follow up time points in the database. We included patients with at least two sets of radiographs within these intervals of LDA and/or remission. Radiographic progression was measured with the Ratingen-score (range 0-190), which describes joint erosions numerically. Repair was defined as an improvement in the Ratingen score >5 points/year and progression as >2 or >5 points change in the Ratingen score within one year.Results:Among 10’141 RA patients, 4’342 episodes of remission occurred in 3’927 patients with 1’776 sets of X rays available within these episodes. Similarly, 8’136 episodes of LDA in 6’765 patients and 2’358 sets of X rays were present within these intervals. For patients in LDA or remission, rates of repair were 5.5% and 4.8%, respectively, while for radiographic progression >5 points in the Ratingen score/year were 10.3% in both groups and for >2 points change of Ratingen score/year were 27.7 and 25.4%, respectively).No differences for demographic factors or measures of disease activity, rheumatoid factor or ACPA were found comparing patients with radiographic progression or non-progression despite LDA or remission at the beginning of the episode of LDA and/or remission.Interestingly, 42.9% of patients in LDA with progression of >5 points in the Ratingen score/year were current smokers vs 29.4% among the non-progressors (X2 = 6.55, p = 0.01). This significant difference vanished when the cut-off for radiographic progression was set at >2 points yearly change in Ratingen score or in patients in remission.Conclusion:Radiographic progression despite LDA or remission are more frequent than expected. No differences in radiographic progression were found comparing LDA and remission suggesting that the goal of LDA is appropriate. Smoking seems to be an independent risk factor for radiographic progression despite LDA. Why the effect of smoking could was not demonstrated in patients in remission, remains unclear.Disclosure of Interests:Lena Brandt: None declared, Hendrik Schulze-Koops: None declared, Thomas Hügle Consultant of: GSK, Abbvie, Pfizer, Jansen, Novartis, Eli Lilly., Michael J. Nissen Consultant of: Abbvie, Celgene, Eli-Lilly, Janssen, Novartis and Pfizer, Hasler paul Consultant of: Abbvie, Lilly, Rudiger Muller Consultant of: AbbVie, Novartis, Grant/research support from: Gebro
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[Arachnoiditis following spinal anesthesia-Case report and review of the literature]. Anaesthesist 2021; 70:497-503. [PMID: 33721039 DOI: 10.1007/s00101-021-00938-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/11/2021] [Accepted: 02/06/2021] [Indexed: 11/24/2022]
Abstract
A 61-year-old woman underwent a tension-free vaginal tape (TVT) operation due to stress incontinence. After technically difficult spinal anesthesia with two attempts the patient developed symptoms of nerve irritation, complained about neckache and headache and showed signs of agitation. The regimen was shifted to general anesthesia and surgery was performed. Because of postoperatively persistent headache and sensory disturbances an MRI scan of the lumbar spine was performed on the first postoperative day without pathological findings. The patient was able to leave the hospital after 1 week with significant relief of symptoms but 3 weeks later she developed neurocognitive impairment with memory deficits. A second MRI scan of the head now showed signs of disturbance of CSF circulation with hydrocephalus. Treatment was performed with drainage and ventriculoperitoneal shunt. Further evaluation showed a severe, multisegmental arachnoiditis and the patient developed a progressive paraparesis. The patient presented her case for assessment to a commission on medical malpractice 13 months after anesthesia. The commission detected no treatment errors. In connection to the case report a literature review of characteristics and etiologies of chronic adhesive arachnoiditis is given, which is a known but very rare complication of spinal anesthesia or similar procedures.
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Scenarios of cost-savings associated with Oncotype DX® test-guided decisions for adjuvant chemotherapy in early breast cancer in Germany. Breast 2021. [DOI: 10.1016/s0960-9776(21)00126-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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[A protestant pastor as the pioneer of emergency medicine : Sebastianus Albinus published the first emergency manual 400 years ago]. Anaesthesist 2021; 69:277-283. [PMID: 32166397 DOI: 10.1007/s00101-020-00748-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In 1588 Sebastian Weiß, the son of a miller, became the first Lutheran pastor of Dittersbach in Saxony. At home he had repeatedly witnessed successful resuscitation of drowned persons by means of simple measures by his parents. Missing appropriate recommendations in the medical literature, in 1620 as "Sebastianus Albinus" he published a booklet with measures for reviving apparently drowned persons. This Kurtze Bericht und Handgrieff (Brief report and handgrip) attracted great attention amongst physicians, especially the reprint of 1675 of which a few copies still exist. The first printed edition from 1620 was lost until, some years ago, the apparently only still existing copy was rediscovered in the Herzog August Library in Wolfenbüttel.
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Cognitive and emotional empathy in individuals at clinical high risk of psychosis. Acta Psychiatr Scand 2020; 142:40-51. [PMID: 32339254 DOI: 10.1111/acps.13178] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Impairments of social cognition are considered core features of schizophrenia and are established predictors of social functioning. However, affective aspects of social cognition including empathy have far less been studied than its cognitive dimensions. The role of empathy in the development of schizophrenia remains largely elusive. METHODS Emotional and cognitive empathy were investigated in large sample of 120 individuals at Clinical High Risk of Psychosis (CHR-P) and compared with 50 patients with schizophrenia and 50 healthy controls. A behavioral empathy assessment, the Multifaceted Empathy Test, was implemented, and associations of empathy with cognition, social functioning, and symptoms were determined. RESULTS Our findings demonstrated significant reductions of emotional empathy in individuals at CHR-P, while cognitive empathy appeared intact. Only individuals with schizophrenia showed significantly reduced scores of cognitive empathy compared to healthy controls and individuals at CHR-P. Individuals at CHR-P were characterized by significantly lower scores of emotional empathy and unspecific arousal for both positive and negative affective valences compared to matched healthy controls and patients with schizophrenia. Results also indicated a correlation of lower scores of emotional empathy and arousal with higher scores of prodromal symptoms. CONCLUSION Findings suggest that the tendency to 'feel with' an interaction partner is reduced in individuals at CHR-P. Altered emotional reactivity may represent an additional, early vulnerability marker, even if cognitive mentalizing is grossly unimpaired in the prodromal stage. Different mechanisms might contribute to reductions of cognitive and emotional empathy in different stages of non-affective psychotic disorders and should be further explored.
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High-throughput sequencing of integrated HIV-1 reveals novel proviral structures. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30138-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Buoyancy-Driven Flow through a Bed of Solid Particles Produces a New Form of Rayleigh-Taylor Turbulence. PHYSICAL REVIEW LETTERS 2018; 121:224501. [PMID: 30547608 DOI: 10.1103/physrevlett.121.224501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Indexed: 06/09/2023]
Abstract
Rayleigh-Taylor (RT) fluid turbulence through a bed of rigid, finite-size spheres is investigated by means of high-resolution direct numerical simulations, fully coupling the fluid and the solid phase via a state-of-the-art immersed boundary method. The porous character of the medium reveals a totally different physics for the mixing process when compared to the well-known phenomenology of classical RT mixing. For sufficiently small porosity, the growth rate of the mixing layer is linear in time (instead of quadratical) and the velocity fluctuations tend to saturate to a constant value (instead of linearly growing). We propose an effective continuum model to fully explain these results where porosity originated by the finite-size spheres is parametrized by a friction coefficient.
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Abstract
OBJECTIVE There is some evidence that clozapine is significantly underutilised. Also, clozapine use is thought to vary by country, but so far no international study has assessed trends in clozapine prescribing. Therefore, this study aimed to assess clozapine use trends on an international scale, using standardised criteria for data analysis. METHOD A repeated cross-sectional design was applied to data extracts (2005-2014) from 17 countries worldwide. RESULTS In 2014, overall clozapine use prevalence was greatest in Finland (189.2/100 000 persons) and in New Zealand (116.3/100 000), and lowest in the Japanese cohort (0.6/100 000), and in the privately insured US cohort (14.0/100 000). From 2005 to 2014, clozapine use increased in almost all studied countries (relative increase: 7.8-197.2%). In most countries, clozapine use was highest in 40-59-year-olds (range: 0.6/100 000 (Japan) to 344.8/100 000 (Finland)). In youths (10-19 years), clozapine use was highest in Finland (24.7/100 000) and in the publicly insured US cohort (15.5/100 000). CONCLUSION While clozapine use has increased in most studied countries over recent years, clozapine is still underutilised in many countries, with clozapine utilisation patterns differing significantly between countries. Future research should address the implementation of interventions designed to facilitate increased clozapine utilisation.
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Using Genetic Engineering to Improve the Bispecific Antibody Platform for MDS Therapy. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30329-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Persisting Intraventricular Fat-Fluid Levels following Surgery on a Ruptured Dermoid Cyst of the Posterior Fossa. Acta Radiol 2016. [DOI: 10.1177/028418518702800423] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intracranial dermoid cysts occasionally rupture spontaneously into the ventricles or into the subarachnoid space. In such cases, intraventricular fat-fluid levels are invariably evident at computed tomography and may even be visible on a conventional radiograph of the skull. A case is described in which fat was observed to remain in the ventricles long after surgical removal of a dermoid cyst. We think that this fat, by causing obstruction of the cerebrospinal fluid pathways, should be regarded as a potential cause of intermittent elevation of intracranial pressure.
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Comparison of Myelography, CT Myelography and Magnetic Resonance Imaging in Cervical Spondylosis and Disk Herniation. Acta Radiol 2016. [DOI: 10.1177/028418518903000302] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Twenty-six patients with cervical radiculopathy and/or myelopathy caused by spondylosis or disk herniation were examined with myelography, CT myelography and MR. Fourteen of the patients were operated upon and 11 of them underwent postoperative MR and CT. The three radiologic methods provided comparable information about narrowing of the subarachnoid space and compression of the spinal cord. It was more difficult to distinguish bone from soft tissue with MR only, but the combination of MR and conventional radiography gave sufficient information for this differentiation. When radiologic nerve root sheath deformity was compared with clinical radiculopathy, myelography, CT myelography and MR had similar sensitivity and accuracy. Postoperative MR could reveal remaining indentation on the thecal sac and the cord but CT without contrast medium was useful as a complement to determine the aetiology of the indentation. Because MR has several practical advantages, it is well suited as the primary imaging modality, together with conventional radiography, for the preoperative radiologic evaluation of patients with cervical radiculopathy and/or myelopathy. Postoperative MR is useful in patients with persistent or new symptoms.
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Association between impaired fasting glycaemia in pediatric obesity and type 2 diabetes in young adulthood. Nutr Diabetes 2016; 6:e227. [PMID: 27548712 PMCID: PMC5022148 DOI: 10.1038/nutd.2016.34] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 01/09/2023] Open
Abstract
Objectives: In adults, impaired fasting glycemia (IFG) increases the risk for type 2 diabetes mellitus (T2DM). This study aimed to investigate to which extent children with obesity develop T2DM during early adulthood, and to determine whether IFG and elevated hemoglobin A1c (HbA1c) in obese children are risk markers for early development of T2DM. Methods: In this prospective cohort study, 1620 subjects from the Swedish Childhood Obesity Treatment Registry – BORIS who were ⩾18 years at follow-up and 8046 individuals in a population-based comparison group, matched on gender age and living area, were included. IFG was defined according to both ADA (cut-off 5.6 mmol l−1) and WHO (6.1 mmol l−1). Elevated HbA1c was defined according to ADA (cut-off 39 mmol l−1). Main outcome was T2DM medication, as a proxy for T2DM. Data on medications were retrieved from a national registry. Results: The childhood obesity cohort were 24 times more likely to receive T2DM medications in early adulthood compared with the comparison group (95% confidence interval (CI): 12.52–46). WHO-defined IFG predicted future use of T2DM medication with an adjusted hazard ratio (HR) of 3.73 (95% CI: 1.87–7.45) compared with those who had fasting glucose levels <5.6 mmol l−1. A fasting glucose level of 5.6–6.0 mmol l−1, that is, the IFG-interval added by American Diabetes Association (ADA), did not increase the use of T2DM medication more than pediatric obesity itself, adjusted HR=1.72 (0.84–3.52). Elevated levels of HbA1c resulted in an adjusted HR=3.12 (1.50–6.52). More severe degree of obesity also increased the future T2DM risk. CONCLUSION: IFG according to WHO and elevated HbA1c (39–48 mmol l−1), but not the additional fasting glucose interval added by ADA (5.6–6.0 mmol l−1), can be considered as prediabetes in the obese pediatric population in Sweden.
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Combined aerobic exercise and enzyme replacement therapy rejuvenates the mitochondrial-lysosomal axis and alleviates autophagic blockage in Pompe disease. Free Radic Biol Med 2015; 87:98-112. [PMID: 26001726 DOI: 10.1016/j.freeradbiomed.2015.05.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/04/2015] [Accepted: 05/13/2015] [Indexed: 12/22/2022]
Abstract
A unifying feature in the pathogenesis of aging, neurodegenerative disease, and lysosomal storage disorders is the progressive deposition of macromolecular debris impervious to enzyme catalysis by cellular waste disposal mechanisms (e.g., lipofuscin). Aerobic exercise training (AET) has pleiotropic effects and stimulates mitochondrial biogenesis, antioxidant defense systems, and autophagic flux in multiple organs and tissues. Our aim was to explore the therapeutic potential of AET as an ancillary therapy to mitigate autophagic buildup and oxidative damage and rejuvenate the mitochondrial-lysosomal axis in Pompe disease (GSD II/PD). Fourteen weeks of combined recombinant acid α-glucosidase (rhGAA) and AET polytherapy attenuated mitochondrial swelling, fortified antioxidant defense systems, reduced oxidative damage, and augmented glycogen clearance and removal of autophagic debris/lipofuscin in fast-twitch skeletal muscle of GAA-KO mice. Ancillary AET potently augmented the pool of PI4KA transcripts and exerted a mild restorative effect on Syt VII and VAMP-5/myobrevin, collectively suggesting improved endosomal transport and Ca(2+)- mediated lysosomal exocytosis. Compared with traditional rhGAA monotherapy, AET and rhGAA polytherapy effectively mitigated buildup of protein carbonyls, autophagic debris/lipofuscin, and P62/SQSTM1, while enhancing MnSOD expression, nuclear translocation of Nrf-2, muscle mass, and motor function in GAA-KO mice. Combined AET and rhGAA therapy reactivates cellular clearance pathways, mitigates mitochondrial senescence, and strengthens antioxidant defense systems in GSD II/PD. Aerobic exercise training (or pharmacologic targeting of contractile-activity-induced pathways) may have therapeutic potential for mitochondrial-lysosomal axis rejuvenation in lysosomal storage disorders and related conditions (e.g., aging and neurodegenerative disease).
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[Partial anomalous pulmonary venous connection as incidental finding: Explanation for apparently paradoxical central venous blood gas analysis results]. Anaesthesist 2015; 64:754-7. [PMID: 26314742 DOI: 10.1007/s00101-015-0076-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 06/25/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
Abstract
A partial anomalous pulmonary venous connection (PAPVC) is a congenital abnormality of the great thoracic vessels the incidence of which is underestimated and is associated with a left-right shunt. It rarely develops into a right-sided cardiac insufficiency. Because of the mostly low left-right shunt volume, a PAPVC is often asymptomatic and mostly incidentally detected in advanced age. Incorrect positioning of a central venous catheter or paradoxical blood gas parameters can serve to indicate the presence of a PAPVC. This article presents the case a 50-year-old patient with a PAPVC of the left upper lobe pulmonary vein draining into the left innominate vein without prior clinical symptoms. Blood gas analyses from the superior vena cava, where the catheter placement was confirmed by computed tomography angiography, showed unexplainable arterial values. The anatomical abnormality was confirmed by computed tomography.
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Family History of Malignant Disease in Non-Hodgkin�s Lymphoma Patients in Comparison with Other Tumor Types. Fam Cancer 2015. [DOI: 10.1159/000412564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Limitations to Participation in Opioid Maintenance Treatment in Europe. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30403-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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[Tapia's syndrome : Rare complication of securing airways]. Anaesthesist 2014; 64:122-7. [PMID: 25523320 DOI: 10.1007/s00101-014-2397-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/09/2014] [Accepted: 10/09/2014] [Indexed: 01/07/2023]
Abstract
Nerve injuries are a rare complication of airway management. Two cases of Tapia's syndrome following orotracheal intubation are reported. Case 1: a 23-year-old male patient underwent an otorhinolaryngology (ENT) surgical procedure with orotracheal intubation. A left-sided Tapia's syndrome was verified 3 days later. Case 2: a 67-year-old patient developed a right-sided Tapia's syndrome following an arthroscopic intervention of the left shoulder in the beach-chair position. In both cases there was permanent damage of both nerves. On the basis of a comprehensive literature survey the reasons for an intubation-induced Tapia's syndrome are discussed. In order to avoid a glottis or immediate subglottic position it is recommended to check and to document the position of the cuff (depth of intubation) and the measured cuff pressure immediately after intubation. It also seems to be advisable to document an overstretched head position if required for the operation.
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Substanzmissbrauchsmuster von Universitätsstudierenden: Regionale und Geschlechtsdifferenzen. SUCHTTHERAPIE 2014. [DOI: 10.1055/s-0034-1374625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Pregabalin is increasingly prescribed for neuropathic pain, generalised anxiety disorder and epilepsy but many patients discontinue treatment. Int J Clin Pract 2014; 68:104-10. [PMID: 23815622 DOI: 10.1111/ijcp.12182] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/04/2013] [Indexed: 12/15/2022] Open
Abstract
AIM To assess prescribing patterns, sociodemographic characteristics and previous disease history in patients receiving pregabalin. METHODS An observational study using register data on dispensed drugs and recorded diagnoses for all patients in Stockholm, Sweden, who filled at least one prescription of pregabalin between July 2005 and December 2009. Analyses focused on prevalence, incidence, diagnosis patterns, prior dispensing of other analgesics/psychotropics and persistence to treatment over time. RESULT A total of 18,626 patients (mean age 55 years, 63% women) were initiated on treatment between July 2006 and December 2009. Approved indications were recorded in hospital and/or primary care within 1 year prior to the first dispensing for 40% of the patients (epilepsy 1.3%, neuropathic pain 35.5% and generalised anxiety disorder (GAD) 3.6%). Antidepressants were used by 55%, opioids by 49% and sedatives by 48% prior to initiation of pregabalin. One-third (34%) only purchased one prescription and the proportion purchasing pregabalin 1 year after initiation was 42.1% for epilepsy, 36.3% for GAD, 21.5% for neuropathic pain and 25.6% for those without any of the included diagnoses. CONCLUSION Pregabalin was mainly used as a second-line drug for the treatment of GAD or neuropathic pain and to a lesser extent as add-on therapy in epilepsy. However, a large proportion of all patients only purchased one prescription and the persistence declined rapidly over time. The issue of potential off-label prescribing or poor registration of diagnoses should also be noted as a high proportion had been prescribed the drug without a record of any of the approved indications.
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028 How Do Clinicians Like and Understand Trustworthy Guidelines? Randomised Controlled Trial Using Clickers in Educational Sessions. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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017PS Using Computerized Decision Support Systems to Improve the Uptake of Guidelines: Perspectives from Different Countries. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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084 PLUGGED-IN (Providing Likeable and Understandable Guidelines using GRADE in the EMR with Direct links to Individual patient data) Phase 2. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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051 Can We Automatically Produce Generic Decision Aids for the Clinical Encounter Directly from GRADE Guideline Recommendations? Experience from the Share-It Project. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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P352 Game-It (Games For Improving Treatment-Recommendations). BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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077 Development of an Evidence to Recommendation Table for Guideline Users. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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313WS Electronic multilayered guideline format: a novel structure and presentation of trustworthy guidelines at the point of care. BMJ Qual Saf 2013. [DOI: 10.1136/bmjqs-2013-002293.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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2138 – Psychiatric comorbidity and mortality in women with anorexia nervosa. Eur Psychiatry 2013. [DOI: 10.1016/s0924-9338(13)77023-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Strongyloidiasis presenting as eosinophilic ascites. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2011; 105:335-8. [PMID: 21871171 DOI: 10.1179/136485911x12987676649863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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FC13-04 - Suicide risk in relation to age and psychiatric hospitalization. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)73589-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IntroductionSuicide risk is increased in patients with a history of psychiatric hospitalization.AimTo explore how suicide risk varies by age during psychiatric hospitalization and in the year post-discharge.MethodsThis is a population-based case-control study of all suicides (n = 20,675; 70% male) in Sweden aged ≥18 years during 1991–2003. Each suicide was individually matched to 10 population controls by age, sex, and county of residence. Discharge diagnoses of a mental disorder (except dementia and other organic disorders) in the year prior to suicide were identified by register linkage. Odds ratios (OR) were calculated by conditional logistic regression to estimate the relative risk of suicide in those with psychiatric diagnoses compared to the general population. ORs were estimated by age group (18–34 years, 35–49 years, 50–64 years, and ≥ 65 years) and timing of the suicide in relation to discharge.ResultsDuring hospitalization, the youngest age group had the greatest suicide risk elevation [OR 64 (95% CI 44-92)]. In the first month post-discharge, the oldest age group had the highest suicide risk elevation [OR 162 (95% 66–399) in the first week and OR 127 (95% 67–242) in the second to fourth weeks]. In the remaining eleven months, suicide risk elevation was lower and relatively similar in different age groups.ConclusionsDuring the year following psychiatric hospitalization, an especially high attention should be paid to the suicide risk of the elderly patients in the first month post-discharge.
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Alternating stimulation of synergistic muscles during functional electrical stimulation cycling improves endurance in persons with spinal cord injury. J Electromyogr Kinesiol 2010; 20:1163-9. [DOI: 10.1016/j.jelekin.2010.07.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 04/27/2010] [Accepted: 07/22/2010] [Indexed: 10/19/2022] Open
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Gegen das Vergessen. Anaesthesist 2010; 59:779-80. [DOI: 10.1007/s00101-010-1747-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Screening and Brief Intervention for Risky Alcohol Consumption in the Workplace: Results of a 1-Year Randomized Controlled Study. Alcohol Alcohol 2010; 45:252-7. [DOI: 10.1093/alcalc/agq021] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Doppelt angelegte Gallenblase – Laparoskopische Cholezystektomie 17 Jahre nach konventioneller Cholezystektomie. Zentralbl Chir 2009; 134:576-9. [DOI: 10.1055/s-0028-1098938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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P16-34. Low frequency of regulatory T cells in peripheral blood from HIV-1+ elite controllers. Retrovirology 2009. [PMCID: PMC2767763 DOI: 10.1186/1742-4690-6-s3-p263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Difference in uptake of tritiated thymidine by myelocytes from bone marrow and spleen in chronic myeloid leukaemia. SCANDINAVIAN JOURNAL OF HAEMATOLOGY 2009; 11:23-6. [PMID: 4518865 DOI: 10.1111/j.1600-0609.1973.tb00092.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Relation between life expectancy and composition of the bone marrow at diagnosis of chronic myeloid leukaemia. SCANDINAVIAN JOURNAL OF HAEMATOLOGY 2009; 12:369-73. [PMID: 4527963 DOI: 10.1111/j.1600-0609.1974.tb00223.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Relief of pruritus as an early sign of spinal cord compression in Hodgkin's disease. ACTA MEDICA SCANDINAVICA 2009; 206:319-20. [PMID: 506805 DOI: 10.1111/j.0954-6820.1979.tb13518.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In a patient with advanced Hodgkin's disease (HD) associated with generalized pruritus, an unexpected relief of itching was found to be an early sign of spinal cord compression. Following irradiation of an extradural mass at the Th II level, itching recurred. Although the mechanisms bringing about itching in HD are unknown, the relief and recurrence of the symptom in our patient are in line with a peripheral origin of pruritus in the disease. Spontaneous relief of pruritus in HD despite other signs of active disease should prompt a neurological examination, since early recognition and treatment of spinal cord compression in lymphoma are important to avoid residual neurological disability.
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Differences in morphology and mitotic activity between intra- and extra-medullary erythropoietic tissue in chronic myeloid leukaemia. SCANDINAVIAN JOURNAL OF HAEMATOLOGY 2009; 13:116-20. [PMID: 4529129 DOI: 10.1111/j.1600-0609.1974.tb00244.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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The cytology, distribution and function of the neoplastic cells in leukaemic reticuloendotheliosis. SCANDINAVIAN JOURNAL OF HAEMATOLOGY 2009; 7:428-34. [PMID: 4927382 DOI: 10.1111/j.1600-0609.1970.tb01927.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
Five out of 74 patients with adult coeliac disease (ACD) diagnosed from 1965 through 1977 developed intestinal lymphoma. The age at diagnosis of ACD was 54-63 years (mean 58) and in all patients an initial improvement was noted on a gluten-free diet. The interval between the diagnoses of ACD and lymphoma was 0.5-6 years (mean 3). In 4 patients the diagnosis of lymphoma was preceded by relapse of diarrhoea and loss of weight despite an adequate diet; 2 patients developed perforation of the bowel. In all patients who subsequently developed lymphoma a pronounced lymphocytopenia, 0.4-1.3 X 10(9)/l, was found at the diagnosis of ACD. It is suggested that ACD patients over 40 who have relapse of malabsorption symptoms despite an adequate diet should be investigated for the presence of an intestinal lymphoma. The suspicion of a malignant transformation may be especially strong if a previous, pronounced lymphocytopenia has been recorded. Three patients died 1-12 months after the diagnosis of lymphoma. However, 2 patients are in good condition 14 and 20 months, respectively, after laparotomy and removal of the tumour, indicating that an early diagnosis and treatment may have a reasonably palliative effect in some cases.
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Abstract
In 11 patients with an average peripheral blood lymphocyte count of 21.1 x 109/l at the time of diagnosis of chronic lymphocytic leukemia (CLL), WBC and differential counts had been recorded on 1-26 occasions more than 5 years before the diagnosis. The median lymphocyte count in the preleukemic period was 1.3 x 109/l found in a sex- and age-matched control series. In 3 patients lymphocytopenia coexisted with normal levels of serum immunoglobulins in the preleukemic period. It is suggested that the preleukemic lymphocytopenia was mainly due to low numbers of T-cell and that a deficiency in T-lymphocytes may favour the development of the malignant, monoclonal B-cell proliferation characteristic of CLL.
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