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Jakobsson RG, Nasic S, Bratt O, Johansson ME, Grenabo Bergdahl A. Family History and Risk of Renal Cell Carcinoma: A National Multiregister Case-Control Study. J Urol 2024; 211:71-79. [PMID: 37862613 DOI: 10.1097/ju.0000000000003765] [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: 03/16/2023] [Accepted: 10/12/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE Our purpose was to investigate the association between family history of renal cell carcinoma (RCC) and RCC risk. MATERIALS AND METHODS RCC cases diagnosed in Sweden between 2005 and 2014 and 10 matched controls were identified using the Renal Cell Cancer Database Sweden, with linkage to the Multigeneration Register and the Swedish Cancer Registry. The association between a family history of RCC and RCC was investigated, overall and by sex and age groups. RESULTS Among 9416 RCC cases, 294 (3.1%) had 1 or more parent or sibling (first-degree relative [FDR]) with RCC. Median age at diagnosis for cases with an affected FDR was 65 years (IQR 59-71) and 68 years (IQR 60-75) for all cases. The proportion of women was significantly higher among familial RCC compared to sporadic RCC (44.6% vs 38.5%, P = .035). RCC was twice as likely with 1 or more FDR with RCC (OR 1.9; CI 1.65-2.16). Stratified analysis showed an OR of 2.4 for women (CI 1.93-2.92) and 1.6 for men (CI 1.35-1.93). Two or more FDRs was associated with a sixfold increased risk (95% CI 2.37-15.5). Familial RCC was strongly associated with bilateral and multifocal tumors (OR 5.5; CI 2.36-13.0, OR 3.5; CI 1.89-6.49). CONCLUSIONS In this Swedish data set, 3.1% of RCC patients have 1 or more FDR diagnosed with RCC. There was no statistical difference in median age between sporadic RCC and familial RCC. Having 1 or more FDR with RCC approximately doubles the risk of RCC with a higher risk increase for women than for men. People with 2 FDRs with RCC constitute a small high-risk group that may benefit from screening.
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Affiliation(s)
- Rasmus G Jakobsson
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Center for Cancer Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Skaraborgs Hospital, Department of Surgery and Urology, Skövde, Sweden
| | - Salmir Nasic
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Skaraborgs Hospital, Research, Education, Development and Innovation Department, Skövde, Sweden
| | - Ola Bratt
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Urology, Gothenborg, Sweden
| | - Martin E Johansson
- Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Center for Cancer Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Grenabo Bergdahl
- Region Västra Götaland, Skaraborgs Hospital, Research, Education, Development and Innovation Department, Skövde, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Urology, Gothenborg, Sweden
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Peters B, Beige J, Siwy J, Rudnicki M, Wendt R, Ortiz A, Sanz AB, Mischak H, Reich HN, Nasic S, Mahmood D, Persson A, Fernström A, Weiner M, Stegmayr B. Dynamics of urine proteomics biomarker and disease progression in patients with IgA nephropathy. Nephrol Dial Transplant 2023; 38:2826-2834. [PMID: 37349951 PMCID: PMC10689155 DOI: 10.1093/ndt/gfad125] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Immunoglobulin A nephropathy (IgAN) frequently leads to kidney failure. The urinary proteomics-based classifier IgAN237 may predict disease progression at the time of kidney biopsy. We studied whether IgAN237 also predicts progression later in the course of IgAN. METHODS Urine from patients with biopsy-proven IgAN was analyzed using capillary electrophoresis-mass spectrometry at baseline (IgAN237-1, n = 103) and at follow-up (IgAN237-2, n = 89). Patients were categorized as "non-progressors" (IgAN237 ≤0.38) and "progressors" (IgAN237 >0.38). Estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio slopes were calculated. RESULTS Median age at biopsy was 44 years, interval between biopsy and IgAN237-1 was 65 months and interval between IgAN237-1 and IgAN237-2 was 258 days (interquartile range 71-531). IgAN237-1 and IgAN237-2 values did not differ significantly and were correlated (rho = 0.44, P < .001). Twenty-eight percent and 26% of patients were progressors based on IgAN237-1 and IgAN237-2, respectively. IgAN237 inversely correlated with chronic eGFR slopes (rho = -0.278, P = .02 for score-1; rho = -0.409, P = .002 for score-2) and with ±180 days eGFR slopes (rho = -0.31, P = .009 and rho = -0.439, P = .001, respectively). The ±180 days eGFR slopes were worse for progressors than for non-progressors (median -5.98 versus -1.22 mL/min/1.73 m2 per year for IgAN237-1, P < .001; -3.02 vs 1.08 mL/min/1.73 m2 per year for IgAN237-2, P = .0047). In multiple regression analysis baseline progressor/non-progressor according to IgAN237 was an independent predictor of eGFR180days-slope (P = .001). CONCLUSION The urinary IgAN237 classifier represents a risk stratification tool in IgAN also later in the course of the dynamic disease. It may guide patient management in an individualized manner.
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Affiliation(s)
- Björn Peters
- Department of Molecular and Clinical Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
| | - Joachim Beige
- Kuratorium for Dialysis and Transplantation, Neu Isenburg/Leipzig, Germany
- Division of Nephrology, Rheumatology and Endocrinology, Martin-Luther University Halle-Wittenberg, Halle/Saale., Germany
| | | | - Michael Rudnicki
- Department of Internal Medicine IV – Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Ralph Wendt
- Division of Nephrology and KfH Renal Unit, Hospital St Georg, Leipzig, Germany
| | - Alberto Ortiz
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD UAM), Madrid, Spain
| | - Ana Belen Sanz
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD UAM), Madrid, Spain
| | | | - Heather N Reich
- Department of Medicine, University of Toronto and Division of Nephrology, University Health Network, Toronto, Ontario, Canada
- Gabor Zellerman Chair in Nephrology Research, University of Toronto, Toronto, Ontario, Canada
| | - Salmir Nasic
- Department of Molecular and Clinical Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Research and Development Centre at Skaraborg Hospital, Skövde, Sweden
| | - Dana Mahmood
- Department of Public Health and Clinical Medicine, Unit Östersund, Umeå University, Umea, Sweden
| | - Anders Persson
- Department of Public Health and Clinical Medicine, Unit Sundsvall, Umeå University, Umea, Sweden
| | - Anders Fernström
- Department of Nephrology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Maria Weiner
- Department of Nephrology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Bernd Stegmayr
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Nasic S, Peters B, Stegmayr B, Kenne Sarenmalm E, Afghahi H, Eriksson M. Sex-specific time trends of long-term graft survival after kidney transplantation - a registry-based study. Ren Fail 2023; 45:2270078. [PMID: 37882045 PMCID: PMC11001319 DOI: 10.1080/0886022x.2023.2270078] [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: 05/25/2023] [Accepted: 10/08/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Sex-specific trends over time with respect to kidney graft survival have scarcely been described in earlier studies. The present study aimed to examine whether kidney graft survival differs between women and men over time. METHODS This study was based on prospectively collected data extracted from a quality registry including all kidney transplant patients between January 1965 and September 2017 at the transplantation center of a university hospital in Sweden. The transplantation center serves a population of approximately 3.5 million inhabitants. Only the first graft for each patient was included in the study resulting in 4698 transplantations from unique patients (37% women, 63% men). Patients were followed-up until graft failure, death, or the end of the study. Death-censored graft survival analysis after kidney transplantation (KT) was performed using Kaplan-Meier analysis with log-rank test, and analysis adjusted for confounders was performed using multivariable Cox regression analysis. RESULTS Median age at transplantation was 48 years (quartiles 36-57 years) and was similar for women and men. Graft survival was analyzed separately in four transplantation periods that represented various immunosuppressive regimes (1965-1985, 1986-1995, 1996-2005, and 2006-2017). Sex differences in graft survival varied over time (sex-by-period interaction, p = 0.026). During the three first periods, there were no significant sex differences in graft survival. However, during the last period, women had shorter graft survival (p = 0.022, hazard ratio (HR) 1.71, 95% confidence interval (CI) 1.1-2.7, adjusted for covariates). Biopsy-proven rejections were more common in women. CONCLUSIONS In this registry-based study, women had shorter graft survival than men during the last observation period (years 2006-2017).
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Affiliation(s)
- Salmir Nasic
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development and Innovation Department, Skaraborg Hospital, Skövde, Sweden
| | - Björn Peters
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
| | - Bernd Stegmayr
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Elisabeth Kenne Sarenmalm
- Research, Education, Development and Innovation Department, Skaraborg Hospital, Skövde, Sweden
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Henri Afghahi
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
| | - Marie Eriksson
- Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
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Stevanovic D, Nasic S, Doric A, Wentz E, Knez R. The Structure and Diagnostic Accuracy of the QbTest in Pediatric ADHD: A Retrospective Clinical Study. J Atten Disord 2023; 27:1296-1305. [PMID: 37199293 DOI: 10.1177/10870547231174035] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVE The QbTest that combines a continuous performance task (CPT) with a motion-tracking system may help identify attention deficit hyperactivity disorder (ADHD). This study examined the structure and diagnostic ability of the QbTest in children and adolescents. METHOD Retrospective data from 1,274 children and adolescents were analyzed. The study assessed data on a principal component analysis (PCA), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS The QbActivity component included the variables micro-events, distance, area, and time active; the QbImpulsivity included normalized commissions and commissions (anticipatory errors were added in a version for 6-12-year-olds only); and the QbInattention included omissions, reaction time, and reaction time variation. Sensitivity ranged between 22% and 50%, specificity 79% and 96%, PPVs 40% and 95%, and NPVs 24% and 66%. CONCLUSION The structure of the QbTest with three cardinal parameters and nine/ten CPT and motion analysis variables was supported. The diagnostic accuracy was found to be poor to moderate. Given that this is a retrospective study, the interpretation of diagnostic accuracy should be considered within this context.
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Affiliation(s)
- Dejan Stevanovic
- Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
- University of Gothenburg, Sweden
| | - Salmir Nasic
- University of Gothenburg, Sweden
- Skaraborgs Hospital, Skövde, Sweden
| | - Ana Doric
- University of Rijeka, Croatia
- IntechOpen Limited, Rijeka, Croatia
| | | | - Rajna Knez
- University of Gothenburg, Sweden
- Skaraborgs Hospital, Skövde, Sweden
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Lundqvist S, Knez R, Nagy K, Nasic S, Kerekes N, Kantzer A. Prevalence of chronic pain in children and adolescents with psychiatric conditions. Paediatr Neonatal Pain 2023; 5:50-56. [PMID: 37283952 PMCID: PMC10240401 DOI: 10.1002/pne2.12100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 01/17/2023] [Accepted: 02/09/2023] [Indexed: 06/08/2023]
Abstract
The prevalence of pain in children and adolescents with psychiatric conditions is rarely investigated. The aims of the current study were to (a) describe the prevalence of headaches and abdominal pain in children and adolescents with psychiatric conditions, (b) compare the prevalence of pain in children and adolescents with psychiatric conditions with that in the general population, and (c) investigate the associations between pain experience and different types of psychiatric diagnoses. Families with a child aged 6-15 years who had been referred to a child and adolescent psychiatry (CAP) clinic completed the Chronic Pain in Psychiatric Conditions questionnaire. Information about the child/adolescent's psychiatric diagnosis(es) was extracted from the CAP clinic's medical records. The children and adolescents included in the study were divided into diagnostic groups and compared. Their data were also compared with data of control subjects collected during a previous study of the general population. Abdominal pain was more common among girls with a psychiatric diagnosis (85%) than in the matched control population (62%, p = 0.031). Children and adolescents with neurodevelopmental diagnoses had a higher prevalence of abdominal pain than children and adolescents with other psychiatric diagnoses. Pain conditions in children and adolescents with a psychiatric diagnosis are common and must be addressed.
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Affiliation(s)
- Sara Lundqvist
- Institute for Neuroscience and PhysiologyGothenburg UniversityGothenburgSweden
- Child and Adolescent Psychiatric ClinicSahlgrenska University HospitalGothenburgSweden
| | - Rajna Knez
- Institute for Neuroscience and PhysiologyGothenburg UniversityGothenburgSweden
- Department of PaediatricsSkaraborg's HospitalSkövdeSweden
| | - Karin Nagy
- Child and Adolescent Psychiatric ClinicSahlgrenska University HospitalGothenburgSweden
| | | | - Nóra Kerekes
- Department of Health SciencesUniversity WestTrollhättanSweden
| | - Anne‐Katrin Kantzer
- Department of Child and Adolescent PsychiatryNU Hospital GroupTrollhättanSweden
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Janeva S, Krabbe E, Parris TZ, Nasic S, Sundquist M, Karlsson P, Audisio RA, Olofsson Bagge R, Kovács A. Clinical evaluation of molecular surrogate subtypes in patients with ipsilateral multifocal primary breast cancer. Breast Cancer Res 2023; 25:36. [PMID: 37024949 PMCID: PMC10080895 DOI: 10.1186/s13058-023-01632-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/02/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND When ipsilateral multifocal primary breast cancer (IMBC) is detected, standard routine is to evaluate the largest tumor with immunohistochemistry (IHC). As all foci are not routinely characterized, many patients may not receive optimal adjuvant treatment. Here, we assess the clinical relevance of examining at least two foci present in patients with IMBC. METHODS Patients diagnosed and treated for IMBC at Sahlgrenska University Hospital (Gothenburg, Sweden) between 2012 and 2017 were screened. In total, 180 patients with ≥ 2 invasive foci (183 specimens) were assessed with IHC and included in this study. Expression of the estrogen (ER) and progesterone (PR) receptors, Ki67, HER2, and tumor grade were used to determine the molecular surrogate subtypes and discordance among the foci was recorded. An additional multidisciplinary team board was then held to re-assess whether treatment recommendations changed due to discordances in molecular surrogate subtype between the different foci. RESULTS Discordance in ER, PR, HER2, and Ki67 was found in 2.7%, 19.1%, 7.7%, and 16.9% of invasive foci, respectively. Discordance in the molecular surrogate subtypes was found in 48 of 180 (26.7%) patients, which resulted in therapy changes for 11 patients (6.1%). These patients received additional endocrine therapy (n = 2), chemotherapy (n = 3), and combined chemotherapy and trastuzumab (n = 6). CONCLUSION Taken together, when assessing at least two tumor foci with IHC, regardless of shared morphology or tumor grade between the different foci, 6.1% of patients with IMBC were recommended additional adjuvant treatment. A pathologic assessment using IHC of all foci is therefore recommended to assist in individualized treatment decision making.
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Affiliation(s)
- Slavica Janeva
- Department of Surgery, Sahlgrenska Breast Center, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
- Department of Clinical Pathology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Ellen Krabbe
- Department of Surgery, Kungälv Hospital, Region Västra Götaland, Kungälv, Sweden
| | - Toshima Z Parris
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Center for Cancer Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Sundquist
- Department of Surgery, Kalmar County Hospital, Kalmar, Sweden
| | - Per Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Oncology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Riccardo A Audisio
- Department of Surgery, Sahlgrenska Breast Center, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Department of Surgery, Sahlgrenska Breast Center, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
- Sahlgrenska Center for Cancer Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anikó Kovács
- Department of Clinical Pathology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Pathology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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Chamalidou C, Nasic S, Linderholm B. Compliance to adjuvant endocrine therapy and survival in breast cancer patients. Cancer Treat Res Commun 2023; 35:100704. [PMID: 37031604 DOI: 10.1016/j.ctarc.2023.100704] [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: 02/03/2023] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Data on compliance to adjuvant endocrine treatment (ET) is mainly reported from prospective clinical trials or from smaller retrospective cohorts without correlation to outcome. AIMS To determine compliance to adjuvant ET and the impact on survival in a population-based series of patients with early breast cancer (BC) advised ET. PATIENTS AND METHODS 1090 consecutive patients with hormone receptor positive (HR+) stage I-III BC diagnosed from 1 January 1997 to 31 December 2003 from one health care region of Sweden were included. Data on tumour, type of ET, compliance, reason for termination and outcome were collected. Statistical analyses were calculated with patients in three groups. RESULTS 72 patients were excluded leaving 1018 patients with a HR+ stage I to III BC for analyses. The most common ET was tamoxifen (n = 751, 73.8%). At the last follow up (31 Dec 2019) with a median follow-up of 18 years (interquartile range 16-22) 228 (22.4%) patients had a relapse. 71.1% of the included patients were compliant to endocrine therapy. Older patients ≥74 years had lower compliance, 61% compared with 75% in the other age groups (≤50 years and 51-73 years) (p < 0001), other parameters including type of ET were not associated with compliance. Low compliance remained as an independent risk factor in multivariate analyses for lower relapse-free survival, HR=1.83, 95% Confidence Interval (CI) 1.52-2.19, p < 0.001 and for time to BC death, HR=2.69, 95%CI 1.82-3.98, p < 0.001. CONCLUSIONS Patients compliant to adjuvant ET have an improved survival.
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Affiliation(s)
- Chaido Chamalidou
- Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy at Gothenburg University, Sweden; Skaraborg Hospital, Department of Oncology, Skövde, Sweden.
| | - Salmir Nasic
- Research and Development Centre, Skaraborgs Hospital, Skövde, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Barbro Linderholm
- Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy at Gothenburg University, Sweden; Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Mölne J, Nasic S, Bröcker V, Stegmayr B, Felldin M, Peters B. Glomerular macrophage index (GMI) in kidney transplant biopsies is associated with graft outcome. Clin Transplant 2022; 36:e14816. [PMID: 36066318 PMCID: PMC10077994 DOI: 10.1111/ctr.14816] [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: 06/24/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Macrophages in renal transplants have been shown to participate in antibody-mediated rejection and are associated with impaired renal function. We calculated the glomerular macrophage index (GMI) in a large transplant biopsy cohort, studied its quantity in different diagnostic groups, to clarify its possible impact on graft survival. METHODS GMI, defined as the mean number of macrophages in 10 glomeruli, was prospectively quantified in 1440 renal transplant biopsies over a 10-year period. The main histopathological diagnoses were grouped into eight disease entities, and GMI was compared to normal transplant biopsies as the reference group. The impact of GMI on graft survival was analyzed. RESULTS GMI was highest in chronic (mean 9.4) and active (9.7) antibody mediated rejections (ABMR), mixed rejections (7.6), and recurrent or de novo glomerulonephritis (7.5) and differed significantly from normal transplants (1.3) in almost all diagnostic groups. Hazard ratios for graft loss were significantly increased for all biopsies with GMI ≥1.9 compared to GMI < .5 (reference group) in an adjusted Cox regression model and increased with higher GMI levels. Biopsies with GMI ≥ 4.6 had < 60% 10-year graft-survival, compared to > 80% with GMI ≤ 1.8. CONCLUSION GMI levels were predictive of graft loss independent of histological diagnoses and may guide clinicians to decide follow-up and therapy.
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Affiliation(s)
- Johan Mölne
- Institute of Biomedicine, Department of Laboratory Medicine, University of Gothenburg, Gothenburg, Sweden.,Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Salmir Nasic
- Department of Molecular and Clinical Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Research and Development Centre, Skaraborg Hospital, Skövde, Sweden
| | - Verena Bröcker
- Institute of Biomedicine, Department of Laboratory Medicine, University of Gothenburg, Gothenburg, Sweden.,Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bernd Stegmayr
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Marie Felldin
- Department of Transplantation University of Gothenburg, Gothenburg, Sweden
| | - Björn Peters
- Department of Molecular and Clinical Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
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Afghahi H, Nasic S, Rydell H, Svensson J, Peters B. The association between long-term glycemic control and all-cause mortality is different among older versus younger patients with diabetes mellitus and maintenance hemodialysis treatment. Diabetes Res Clin Pract 2022; 191:110033. [PMID: 35940301 DOI: 10.1016/j.diabres.2022.110033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022]
Abstract
AIMS Knowledge about association between glycated hemoglobin (HbA1c) and risk of all-cause mortality in patients with diabetes mellitus on maintenance hemodialysis (HD)-treatment is sparse. The study aims to investigate association between HbA1c and all-cause mortality in patients with diabetes and maintenance HD-treatment, separately for two age groups- above and below 75 years. METHODS 2487 patients (mean age 66 years, 66 % men) were separated in two age groups: ≤75 years (n = 1810) and > 75 years (n = 677) and followed up between 2008 and 2018. Hazard ratios (HR) and 95 % confidence intervals (CI) for associations between HbA1c and all-cause mortality were calculated using Cox-regression-models. RESULTS 1295 (52 %) patients died and 473 (70 %) among the patients above 75 years old. In the multivariate analysis, HbA1c5-6 % was used as reference. In patients ≤ 75 years old, only increased HbA1c > 9.7 %, HR2.03(CI1.43-2.89) was associated with increased risk of all-cause mortality. In patients > 75 years, HbA1c ≤ 5 %, HR1.67(CI1.16-2.40); HbA1c6.9-7.8 %, HR1.41(CI1.03-1.93) and HbA1c8.7-9.7 %, HR1.79 (CI1.08-2.96) were associated with increased risk of all-cause mortality. CONCLUSIONS We found a J-shaped association between HbA1c and mortality only in diabetic HD-patients > 75 years. This probably indicates that in an old population of diabetic HD-patients, both intensive glucose control and hyperglycemia could be harmful and associated with higher risk of death.
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Affiliation(s)
- Hanri Afghahi
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Salmir Nasic
- Research and Development Centre at Skaraborg Hospital, Skövde, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Helena Rydell
- Karolinska University Hospital, Stockholm Division of Renal Medicine, CLINTEC, Karolinska Institutet, Sweden
| | - Johan Svensson
- Research and Development Centre at Skaraborg Hospital, Skövde, Sweden; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Björn Peters
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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10
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Stevanovic D, Wentz E, Nasic S, Knez R. ASD with ADHD vs. ASD and ADHD alone: a study of the QbTest performance and single-dose methylphenidate responding in children and adolescents. BMC Psychiatry 2022; 22:282. [PMID: 35448977 PMCID: PMC9022263 DOI: 10.1186/s12888-022-03878-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/24/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The continuous performance task (CPT) may help identify coexistent attention deficit hyperactivity disorder (ADHD) in autism spectrum disorder (ASD). The Quantified behavior Test (QbTest) combines a CPT and motion-tracking data to assess ADHD symptoms. This study aimed to evaluate the QbTest performance of children and adolescents with ASD plus ADHD, including estimating the effects of single-dose methylphenidate (MPH). To achieve these aims, (1) the QbTest performances were evaluated in ASD alone, ASD plus ADHD, and ADHD alone, and (2) the effects on the QbTest performance of single-dose MPH before and after intake were estimated across the groups. It was assumed that the ASD plus ADHD performance, including the MPH response, would preferably resemble the performance in ADHD alone, rather than ASD alone. METHODS Retrospective data were analyzed for 482 children and adolescents: 69 with ASD alone, 142 with ASD plus ADHD (ASD/ADHD), and 271 with ADHD alone. For 343 subjects, the QbTest was performed before and up to four hours after a single-dose MPH intake. A summary index of the CPT and motion-capture data was provided for QbTest cardinal parameters. RESULTS Of 12 QbTest parameters assessed before given MPH, the ASD/ADHD group had scores in line with the ASD group regarding four parameters and the ADHD group regarding nine parameters. Significant differences between groups were seen with respect to QbInattention (p > 0.05); the lowest scores in ASD and the highest in ADHD. Those with ASD/ADHD and ADHD had similar QbActivity and QbImpulsivity scores, but significantly higher than those with ASD. After MPH intake, scores for QbActivity decreased similarly in ASD/ADHD and ADHD, as well as scores for QbImpulsivity. QbImpulsivity increased in ASD. QbInattention scores decreased similarly in all groups after MPH intake. CONCLUSIONS Children and adolescents with ASD plus ADHD exhibited more atypical QbTest performances than those with ASD alone, while most of their performances were similar to those observed in ADHD alone. In addition, a single dose of MPH mitigated attention deficits and decreased hyperactivity while improved impulsivity in these children. Prospective studies should further clarify the role of the QbTest in the diagnostic and therapeutic interventions in ASD with ADHD.
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Affiliation(s)
- Dejan Stevanovic
- grid.8761.80000 0000 9919 9582Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 430, 40530 Göteborg, Sweden ,Psychiatry Department, Clinic for Neurology and Psychiatry for Children and Youth, Dr Subotic 6a, 11000 Belgrade, Serbia
| | - Elisabet Wentz
- grid.8761.80000 0000 9919 9582Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 430, 40530 Göteborg, Sweden
| | - Salmir Nasic
- grid.416029.80000 0004 0624 0275Research & Development Centre, Skaraborgs Hospital, Lövängsvägen, 541 42 Skövde, Sweden ,grid.8761.80000 0000 9919 9582Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 430, 40530 Göteborg, Sweden
| | - Rajna Knez
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Box 430, 40530, Göteborg, Sweden. .,Department of Pediatrics, Skaraborgs Hospital, Skövde, Sweden.
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11
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Nasic S, Mölne J, Stegmayr B, Peters B. Histological diagnosis from kidney transplant biopsy can contribute to prediction of graft survival. Nephrology (Carlton) 2022; 27:528-536. [PMID: 35150598 PMCID: PMC9302625 DOI: 10.1111/nep.14028] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/29/2022]
Abstract
Aim The primary aim of this study was to in depth examine if the histological findings in a transplanted kidney biopsy can predict the prognosis for the graft and the patient. The secondary aim was to extend knowledge of the impact of time elapsed on biopsy findings. Methods Data from 1462 patients were merged from a kidney transplantation registry and a biopsy registry during 1 January 2007 and 30 September 2017. Kaplan–Meier analysis and multivariate Cox‐regression analysis were performed and hazard ratios (HR) with 95% confidence intervals (CI) were presented. Results Compared to normal biopsy findings, graft survival after biopsy (gsaBiopsy) was shorter for patients with glomerular diseases (HR 8.2, CI:3.2–21.1), rejections (HR 4.2, CI:1.7–10.3), chronic changes including IFTA (HR 3.2, CI:1.3–8.0), acute tubular injuries (HR 3.0, CI:1.2–7.8), and borderline changes (HR 2.9, CI:1.1–7.6). Sub‐analysis of rejections showed shorter gsaBiopsy for chronic TCMR (HR 4.7, CI:1.9–11.3), active ABMR (HR 3.6, CI:1.7–7.7) and chronic ABMR (HR 3.5, CI:2.0–6.0). Patients with TCMR Banff grade II (HR 0.35, CI:0.20–0.63) and grade I (HR 0.52, CI:0.29–0.93) had a better gsaBiopsy compared to all other types of rejections. Conclusion Shorter gsaBiopsy was noted in kidneys with glomerular diseases, rejections, acute tubular injuries and borderline changes. TCMR Banff rejections grade I and II were associated with a better prognosis. This Swedish single centre study showed that the impact on allograft survival is dependent on the nature of the biopsy findings, with histological findings of glomerular disease, severe rejections and chronic changes being associated with more rapid allograft loss.
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Affiliation(s)
- Salmir Nasic
- Research and Development Centre at Skaraborg Hospital, Skövde, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johan Mölne
- Institute of Biomedicine, Laboratory Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Bernd Stegmayr
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Björn Peters
- Department of Molecular and Clinical Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Nephrology, Skaraborg Hospital, Skövde, Sweden
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12
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Afghahi H, Nasic S, Peters B, Rydell H, Hadimeri H, Svensson J. Long-term glycemic variability and the risk of mortality in diabetic patients receiving peritoneal dialysis. PLoS One 2022; 17:e0262880. [PMID: 35077471 PMCID: PMC8789125 DOI: 10.1371/journal.pone.0262880] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The large amount of glucose in the dialysate used in peritoneal dialysis (PD) likely affects the glycemic control. The aim of this study was to investigate the association between HbA1c variability, as a measure of long-term glycemic variability, and the risk of all-cause mortality in diabetic patients with PD.
Methods
325 patients with diabetes and ESRD were followed (2008–2018) in the Swedish Renal Registry. Patients were separated in seven groups according to level of HbA1c variability. The group with the lowest variability was denoted the reference. The ratio of the standard deviation (SD) to the mean of HbA1c, HbA1c (SD)/HbA1c (mean), i.e. the coefficient of variation (CV), was defined as HbA1c variability. Hazard ratios (HR) and 95% confidence intervals (CI) were examined using Cox regression analyses.
Results
During follow-up, 170 (52%) deaths occurred. The highest mortality was among patients with the second highest HbA1c variability, CV≥2.83 [n = 44 of which 68% patients died]. In the multivariate analyses where lowest HbA1c variability (CV≤0.51) was used as the reference group, HbA1c CV 2.83–4.60 (HR 3.15, 95% CI 1.78–5.55; p<0.001) and CV> 4.6 (HR 2.48, 95% CI 1.21–5.11; p = 0.014) were associated with increased risk of death.
Conclusion
The high risk of all-cause mortality in patients with diabetes and PD increased significantly with elevated HbA1c variability, as measure of long-term glycemic control. This indicates that stable glycemia is associated with an improvement of survival; whereas more severe glycemic fluctuations, possibly caused by radical changes in dialysis regimes or peritonitis, are associated with a higher risk of mortality in diabetic patients with PD.
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Affiliation(s)
- Hanri Afghahi
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Salmir Nasic
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Research and Development Center at Skaraborg Hospital, Skövde, Sweden
| | - Björn Peters
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Helena Rydell
- Division of Renal Medicine, Department of Clinical Sciences Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Department of Internal Medicine, Swedish Renal Registry, Ryhov Regional Hospital, Jönköping, Sweden
| | - Henrik Hadimeri
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johan Svensson
- Research and Development Center at Skaraborg Hospital, Skövde, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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13
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Johansson YA, Tsevis T, Nasic S, Gillsjö C, Johansson L, Bogdanovic N, Kenne Sarenmalm E. Diagnostic accuracy and clinical applicability of the Swedish version of the 4AT assessment test for delirium detection, in a mixed patient population and setting. BMC Geriatr 2021; 21:568. [PMID: 34663229 PMCID: PMC8522056 DOI: 10.1186/s12877-021-02493-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 04/30/2021] [Accepted: 09/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delirium is common in older hospitalized patients. It has serious consequences e.g., poor health outcomes, mortality and increased costs. Despite that, many cases are undetected. Early detection of delirium is important in improving outcomes and use of assessment tools improves detection rates. The 4AT is a brief screening tool for delirium detection, which has not previously been translated into Swedish. The study aim was to evaluate diagnostic accuracy and clinical applicability of a Swedish version of the screening tool 4AT for delirium detection. METHOD This diagnostic test accuracy study used a quantitative and a qualitative approach and evaluated the patients' and the health care professionals' experiences of the tool. Study included 200 patients ≥65 years from a university hospital and a county hospital in two Swedish regions. Medical specialties were geriatric stroke/neurology, geriatric multimorbidity, severe cognitive impairment, orthopaedic, and urology. The translated 4AT was tested against the reference standard DSM-IV-TR criteria, based on the Organic Brain Syndrome scale and patient records. The 4AT was assessed simultaneously and independently by two assessors. Additionally, data was collected through patient record reviews, and questions about applicability to the patients (n = 200) and the assessors (n = 37). Statistical analyses, and qualitative content analyses were conducted. RESULTS By reference standard 18% had delirium, and by 4AT 19%. The overall percent agreement was 88%, AUROC 0.808, sensitivity 0.70 (95% CI 0.51-0.84) and specificity 0.92 (95% CI 0.87-0.96). In the ward for severe cognitive impairment (n = 63) the 4AT was less sensitive and less specific. In the other wards (n = 132) sensitivity was 0.77 (95% CI 0.50-0.93), specificity 0.93 (95% CI 0.87-0.97), and AUROC 0.848. Interrater reliability (Kappa) was 0.918, p = < 0.001 (n = 144). The 4AT was well tolerated by patients, easy to use for health care professionals, and took a few minutes to conduct. CONCLUSION The Swedish version of 4AT is an accurate and applicable tool to use in clinical practice for detecting delirium in hospitalized patients across different medical specialities, and to use by different professionals and levels of seniority. To improve patient outcomes, we recommend the 4AT to be incorporated in clinical practice in health care settings in Sweden.
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Affiliation(s)
- Yvonne A Johansson
- Skaraborg Hospital, Skövde, Sweden. .,The Research School of Health and Welfare, Aging Research Network-Jönköping (ARN-J), Jönköping University, Jönköping, Sweden.
| | - Theofanis Tsevis
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Salmir Nasic
- Skaraborg Hospital, Skövde, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Catharina Gillsjö
- School of Health Sciences, University of Skövde, Skövde, Sweden.,College of Nursing, University of Rhode Island, Kingston, RI, USA
| | - Linda Johansson
- Institute of Gerontology, Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Nenad Bogdanovic
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Elisabeth Kenne Sarenmalm
- Skaraborg Hospital, Skövde, Sweden.,School of Health Sciences, University of Skövde, Skövde, Sweden.,Institute of Health and Care Science, Sahlgrenska Academy, Centre for Person-Centred Care Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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14
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Nasic S, Mölne J, Stegmayr B, Felldin M, Peters B. MO963GRAFT- AND PATIENT-SURVIVAL AFTER FIRST KIDNEY TRANSPLANT BIOPSY. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab110.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Kidney transplantation is frequently used as a treatment in uremic patients. However, long term function is not easily predicted. The aim of this study was to investigate to what extent histological diagnosis in the first registered transplant kidney biopsy is related to clinical outcome.
Method
Included were data of 1463 patients (36.6 % women, 63.4 % men) that were merged from a kidney transplantation register and a biopsy register. These patients obtained their first registered transplant biopsy during the period January 1, 2007 until July 30, 2017. Fisher’s exact test and χ-2 analyses were used for cross-tabulation of data. Graft- and patient-survival analysis was performed by Kaplan-Meier analysis with log-rank tests comparing different groups and in next step age and gender adjusted analysis were performed by multivariate Cox-regression-analysis. Data are presented as Hazard Ratio (HR) and 95% Confidence Intervals (CI). A two-sided p-value of <0.05 was considered as statistically significant.
Results
The graft-survival was shorter for patients with biopsy-proven glomerular diseases (HR 8.1, CI 3.1-20.7) and rejections (HR 4.3, CI 1.7 -10.5) compared to normal biopsy findings. Further, there was a shorter graft-survival for those with chronic damages (HR 3.2, CI 1.3-8.0), acute tubular injuries (HR 3.0, CI 1.2-7.8), and borderline changes (HR 2.9, CI 1.1-7.6). The patient-survival was reduced for patients with biopsy-proven hematological diseases (HR 9.6, CI 2.1-44.0). Sub analysis of all types of rejections showed shorter graft-survival for chronic T-cell-mediated rejection (TCMR) (HR 4.8, CI 2.1-11.7), active antibody-mediated rejection (ABMR) (HR 4.4, CI 2.1-9.3), chronic ABMR (HR 3.8, CI 2.2-6.7), combined chronic ABMR and TCMR (HR 4.0, CI 2.4-6.9) and other rejections (HR 3.3, CI 1.1-9.6) compared to acute TCMR. Patients with TCMR Banff grade II rejection had a better graft-survival (HR 0.35, CI 0.20-0.63) compared to other rejections as well as patients with TCMR Banff grade I (HR 0.52, CI 0.29-0.93). 265 patients had graft-loss and 42 of those patients died afterwards (15.8%). Of the 42 who died after graft-loss 9 patients died within 30 days after transplant failure (21.4%).
Conclusion
A shorter graft-survival was found in kidneys with glomerular diseases, rejections, acute tubular injuries, borderline changes and chronic damages. A shorter patient-survival was noted for patients with transplant kidney biopsies with hematological diseases. Patients with Banff grade II rejection had a better graft-survival compared to all other diagnosis and other rejections. Further, awareness should be given to patients the first month after graft-loss.
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Affiliation(s)
- Salmir Nasic
- Sahlgrenska Academy at University of Gothenburg, Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden
- Skaraborg Hospital, Research and Development Centre (FoU), Skövde, Sweden
| | - Johan Mölne
- Sahlgrenska Academy at University of Gothenburg, Laboratory Medicine, Biomedicine, Gothenburg, Sweden
| | - Bernd Stegmayr
- Umeå University, Public Health and Clinical Medicine, Umeå, Sweden
| | - Marie Felldin
- Sahlgrenska University Hospital, Transplantation Center, Gothenburg, Sweden
| | - Björn Peters
- Sahlgrenska Academy at University of Gothenburg, Molecular and Clinical Medicine, Institute of Medicine, Gothenburg, Sweden
- Skaraborg Hospital, Nephrology, Skövde, Sweden
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15
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Janeva S, Parris TZ, Nasic S, De Lara S, Larsson K, Audisio RA, Olofsson Bagge R, Kovács A. Comparison of breast cancer surrogate subtyping using a closed-system RT-qPCR breast cancer assay and immunohistochemistry on 100 core needle biopsies with matching surgical specimens. BMC Cancer 2021; 21:439. [PMID: 33879115 PMCID: PMC8059293 DOI: 10.1186/s12885-021-08171-2] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/09/2021] [Indexed: 01/22/2023] Open
Abstract
Background Routine clinical management of breast cancer (BC) currently depends on surrogate subtypes according to estrogen- (ER) and progesterone (PR) receptor, Ki-67, and HER2-status. However, there has been growing demand for reduced immunohistochemistry (IHC) turnaround times. The Xpert® Breast Cancer STRAT4* Assay (STRAT4)*, a standardized test for ESR1/PGR/MKi67/ERBB2 mRNA biomarker assessment, takes less than 2 hours. Here, we compared the concordance between the STRAT4 and IHC/SISH, thereby evaluating the effect of method choice on surrogate subtype assessment and adjuvant treatment decisions. Methods In total, 100 formalin-fixed paraffin-embedded core needle biopsy (CNB) samples and matching surgical specimens for 98 patients with primary invasive BC were evaluated using the STRAT4 assay. The concordance between STRAT4 and IHC was calculated for individual markers for the CNB and surgical specimens. In addition, we investigated whether changes in surrogate BC subtyping based on the STRAT4 results would change adjuvant treatment recommendations. Results The overall percent agreement (OPA) between STRAT4 and IHC/SISH ranged between 76 and 99% for the different biomarkers. Concordance for all four biomarkers in the surgical specimens and CNBs was only 66 and 57%, respectively. In total, 74% of surgical specimens were concordant for subtype, regardless of the method used. IHC- and STRAT4-based subtyping for the surgical specimen were shown to be discordant for 25/98 patients and 18/25 patients would theoretically have been recommended a different adjuvant treatment, primarily receiving more chemotherapy and trastuzumab. Conclusions A comparison of data from IHC/in situ hybridization and STRAT4 demonstrated that subsequent changes in surrogate subtyping for the surgical specimen may theoretically result in more adjuvant treatment given, primarily with chemotherapy and trastuzumab.
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Affiliation(s)
- Slavica Janeva
- Sahlgrenska Breast Center, Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden. .,Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Toshima Z Parris
- Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Center for Cancer Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden
| | - Shahin De Lara
- Department of Clinical Pathology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Karolina Larsson
- Department of Oncology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Riccardo A Audisio
- Sahlgrenska Breast Center, Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.,Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Sahlgrenska Breast Center, Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.,Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anikó Kovács
- Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Pathology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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16
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Karlsson K, Nasic S, Lundberg L, Mårtensson J, Jonsson A. Health problems among Swedish ambulance personnel: long-term risks compared to other professions in Sweden - a longitudinal register study. Int J Occup Saf Ergon 2021; 28:1130-1135. [PMID: 33533685 DOI: 10.1080/10803548.2020.1867400] [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] [Indexed: 10/22/2022]
Abstract
Objectives. This study aimed to investigate whether Swedish ambulance personnel differ in the extent of suffering from health problems compared to other occupational groups. Methods. Two cohorts of ambulance personnel from 2001 and 2008, with 1778 and 2753 individuals, respectively, were followed regarding assignment of diagnostic coding (International Classification of Diseases codes) until 2016. These two cohorts represent all who were employed as ambulance personnel by public employers during these years. Two comparison groups were added: other healthcare workers and other professions. All data were retrieved from national registers. The χ2 test was were used for statistical calculation. Results. Swedish ambulance personnel are at a significantly higher risk of being affected by 'Paroxysmal tachycardia, atrial fibrillation and flutter, other cardiac arrhythmias', by 'Other intervertebral disc disorders' and by 'Arthropathies', when compared to both comparison groups in both cohorts. Almost similar results were seen for 'Gonarthrosis' and for 'Dorsopathies'. Conclusions. Swedish ambulance personnel run the risk of being affected by certain diseases and injuries to a greater extent compared to other professions.
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Affiliation(s)
- Kåre Karlsson
- Ambulance Services, Skaraborg Hospital, Sweden.,Research and Development Centre, Skaraborg Hospital, Sweden.,School of Health and Welfare, Jönköping University, Sweden
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital, Sweden
| | | | - Jan Mårtensson
- School of Health and Welfare, Jönköping University, Sweden
| | - Anders Jonsson
- School of Health Sciences, Borås University, Sweden.,The Swedish Armed Forces, Centre for Defence Medicine, Sweden
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17
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Wärme A, Hadimeri H, Nasic S, Stegmayr B. The association of erythropoietin-stimulating agents and increased risk for AV-fistula dysfunction in hemodialysis patients. A retrospective analysis. BMC Nephrol 2021; 22:30. [PMID: 33461526 PMCID: PMC7814716 DOI: 10.1186/s12882-020-02209-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patients in maintenance hemodialysis (HD) need a patent vascular access for optimal treatment. The recommended first choice is a native arteriovenous fistula (AVF). Complications of AVF are frequent and include thrombosis, stenosis and infections leading to worsening of dialysis efficacy. Some known risk factors are age, gender and the presence of diabetes mellitus. The aim was to investigate if further risk variables are associated with dysfunctional AVF. METHODS This retrospective observational study included 153 chronic HD patients (Cases) referred to a total of 473 radiological investigations due to clinically suspected complications of their native AVF. Another group of chronic HD patients (n = 52) who had a native AVF but were without history of previous complications for at least 2 years were controls. Statistical analyses included ANOVA, logistic regression, parametric and non-parametric methods such as Student's T-test and Mann-Whitney test. RESULTS Among Cases, at least one significant stenosis (> 50% of the lumen) was detected in 348 occasions. Subsequent PTA was performed in 248 (71%). Median erythropoiesis-stimulating agent (ESA) weekly doses were higher in Cases than in Controls (8000 vs 5000 IU, p < 0.001). Cases received higher doses of intravenous iron/week than the Controls before the investigation (median 50 mg vs 25 mg, p = 0.004) and low molecular weight heparin (LMWH, p = 0.028). Compared to Controls, Cases had a lower level of parathyroid hormone (median 25 vs 20 ρmol/L, p = 0.009). In patients with diabetes mellitus, HbA1c was higher among Cases than Controls (50 vs 38 mmol/mol, p < 0.001). Multiple regression analysis revealed significant associations between Cases and female gender, prescription of doxazocin, and doses of ESA and LMWH. There was no difference between the groups regarding hemoglobin, CRP or ferritin. CONCLUSION In conclusion, the present study indicated that the factors associated with AVF problems were high doses of ESA, iron administration, and tendency of thromboembolism (indicated by high LMWH doses); the use of doxazocin prescription, however, requires further investigation.
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Affiliation(s)
- Anna Wärme
- Dept of Internal Medicine and Clinical Nutrition, Institution of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Nephrology, Skaraborg hospital, 541 85 Skovde, Sweden
| | - Henrik Hadimeri
- Dept of Internal Medicine and Clinical Nutrition, Institution of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital, Skovde, Sweden
| | - Bernd Stegmayr
- Dept of Public Health and Clinical Medicine, Umea University, Umea, Sweden
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18
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Knez R, Stevanovic D, Nasic S, Doric A, Wentz E. The Impact of Methylphenidate on QbTest Performance of Children with ADHD: A Retrospective Clinical Study. Neuropsychiatr Dis Treat 2021; 17:19-32. [PMID: 33447036 PMCID: PMC7802589 DOI: 10.2147/ndt.s277490] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/07/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The Quantified behavior Test (QbTest), which combines a continuous performance task (CPT) and motion tracking, provides data for the core signs of attention-deficit/hyperactivity disorder (ADHD): attention, hyperactivity, and impulsivity. This study aimed to evaluate the performance of children and adolescents with ADHD on the QbTest before and after a single methylphenidate (MPH) dose. SUBJECTS AND METHODS This retrospective chart review study included data from 149 children and 215 adolescents who completed the QbTest. A summary index of the CPT and motion capture data on the QbTest is provided by three cardinal parameters: QbActivity, QbImpulsivity, and QbInattention. The test was performed twice on the same day, before and up to three hours after MPH intake. A decrease by ≥ 0.5 in a cardinal parameter score was considered an improvement, whereas an increase by ≥ 0.5 a deterioration. RESULTS QbActivity improvement after MPH intake was present in 71.7% and 76.2% of the children and adolescents, respectively. QbImpulsivity improvement was observed in 50.4% of the children and 44.7% of the adolescents, and QbInattention improvement in 85.1% and 91.1% of the children and adolescents, respectively. All three parameters improved simultaneously in 27.7% of the children and 28.7% of the adolescents. The likelihood that one parameter deteriorated after MPH use was greater if that parameter was within the normal range before medication. This was most pronounced for QbImpulsivity. Among male adolescents, QbInattention improvement was often accompanied by QbImpulsivity deterioration. CONCLUSION The QbTest inattention and motor activity parameters improved markedly after a single MPH dose in children and adolescents with ADHD, while less so for impulsivity. Improvement of one parameter is not necessarily associated with improvement of the other two, and deterioration, especially regarding impulsivity, may occur. If confirmed, these results highlight the need for optimization and individualization of MPH treatment, while monitoring all aspects of the ADHD symptomatology based on the QbTest performance.
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Affiliation(s)
- Rajna Knez
- Department of Pediatrics, Skaraborgs Hospital, Skövde, Sweden; Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Dejan Stevanovic
- Psychiatry Department, Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Salmir Nasic
- Research & Development Centre, Skaraborgs Hospital, Skövde, Sweden
| | - Ana Doric
- Department of Psychology, Faculty of Humanity and Social Sciences, University of Rijeka, Rijeka, Croatia
| | - Elisabet Wentz
- Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Peters B, Nasic S, Jensen G, Stegmayr B. Renal transplant biopsy complications: assessment of risk factors and potential of desmopressin to decrease risk of hemorrhage. Acta Radiol 2020; 61:1717-1723. [PMID: 32212828 DOI: 10.1177/0284185120910590] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Renal transplant biopsies are essential in nephrology; however, they are invasive and complications can occur. PURPOSE To explore the risk of transplant kidney biopsy (TxB) complications in relation to possible preventive effects of desmopressin prophylaxis. MATERIAL AND METHODS A total of 515 consecutive TxB (375 patients, median age 53 years) were analyzed. In 252 TxB, the Resistive Index (RI) was measured right before the biopsy. A total of 282 patients had serum creatinine >150 µmol/L. In one of the six hospitals 39/282 patients consecutively received desmopressin (dose 0.3 µg/kg subcutaneously) as prophylaxis within 1 h before the biopsy. Fisher's exact and χ2 test were used (odds ratio [OR], 95% confidence interval [CI]). Univariate and multiple binary logistic regression analyses were performed. A two-sided P value <0.05 was considered significant. RESULTS RI ≥ 0.8 was a risk factor for major TxB complications (OR 4.2, 95% CI 1.13-15.76). The risk for minor complications decreased with mean arterial blood pressure (MAP) (97.9 vs. 89.5 mmHg, OR 0.97, 95% CI 0.95-0.997). In a multiple regression analysis for overall biopsy complications, the risk remained increased for patients with RI ≥ 0.8 (OR 4.45, 95% CI 1.32-15.04). No patients (0/39) with desmopressin prophylaxis had a major complication versus 8/243 in the other group. In patients with serum creatinine >150 µmol/L, those with a higher MAP had more overall TxB complications (104.5 vs. 98.2 mmHg, OR 1.05, 95% CI 1.004-1.1). CONCLUSION RI ≥ 0.8 was a risk factor for major and overall complications and a lower MAP for minor biopsy complications. Desmopressin prophylaxis showed yet no verified benefit as prophylaxis in TxB.
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Affiliation(s)
- Björn Peters
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Salmir Nasic
- Research Center (FoU) at Skaraborg Hospital, Skövde, Sweden
| | - Gert Jensen
- Department of Molecular and Clinical Medicine/Nephrology, The Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Bernd Stegmayr
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
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Abstract
BACKGROUND Self-rated health (SRH) focuses on the patient's own perception, and represents an important patient-reported outcome. The aim was to investigate SRH one to 5 years after stroke, follow the development over time and search for factors associated with SRH. METHODS Consecutive stroke patients admitted to Stroke Units at the Skaraborg Hospital, Sweden were included 2007-2009 (n = 2190). Patient-reported outcomes were collected annually over 5 years using a postal questionnaire. SRH was assessed by the question about general health from SF-36. Factors associated with SRH were investigated by multiple logistic regression analysis. RESULTS Response-rate was > 90% at all time points. Overall, 40.2, 41.9, 40.7, 45.0 and 46.3% of the patients reported good SRH, 1 to 5 years after stroke. Performance in activities of daily living (ADL) was strongly associated with good SRH; 49.8 and 14.7% after 1 year in independent and dependent survivors respectively, p < 0.001. In independent survivors 1 year after stroke, good SRH was positively associated with female sex (OR = 2.0; p = < 0,001), physical activity (OR = 2.14; p = < 0,001), car driving (OR = 2.25; p = < 0,001), and negatively associated with age (OR = 0.99; p = < 0,001), pain (OR = 0.49; p = < 0,001), depression (OR = 0.30; p = < 0,001), and self-perceived unmet care needs (OR = 0.39; p = < 0,001). In dependent survivors, depression (OR = 0.23; p = < 0,001) and age (OR = 0.96; p = < 0,05), were negatively associated with good SRH 1 year after stroke. Similar patterns were observed throughout the follow-up. CONCLUSION The proportion stroke survivors reporting their health as good is slightly increasing over time. After stroke, SRH is associated with pain, depression, ability to perform activities and self-perceived unmet care needs, indicating that efforts to support stroke survivors in the chronic phase after stroke should concentrate on targeting these factors.
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Affiliation(s)
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden
| | | | - Katarina Jood
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, the Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Rejnö
- Department of Health Sciences, University West, 461 86, Trollhättan, Sweden. .,Department of Medicine, Skaraborg Hospital Skövde, Skövde, Sweden.
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Chamalidou C, Nasic S, Linderholm B. Compliance to adjuvant endocrine treatment – real world data from 1019 consecutive luminal breast cancer patients with long follow-up. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30683-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Wã¤rme AV, Stegmayr B, Nasic S, Hadimeri H. P1351MARKERS FOR AVF DYSFUNCTION; A RETROSPECTIVE ANALYSIS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background and Aims
The native Arterio venous fistula (AVF) is the recommended first choice for regular hemodialysis treatment. However, its patency is mainly limited due to stenosis and thrombosis, leading to insufficient dialysis, costly interventions, subsequent in-hospital care and follow ups.
Primary aim: To find medical or laboratory markers associated with dysfunctional AVF.
Method
Retrospective analysis of radiologic examinations and medical records was made due to clinical suspicion of AVF dysfunction (cases) from two hospitals during 2006-2014. Comparison was made with data from 52 patients without complications (controls) with repeated blood sampling during the same period. Differences between groups were calculated with Mann- Whitney test and paired statistics with Wilcoxon U test before and after examination.
Results
Mean age in both groups was 65 years. In 153 patients 473 radiological examinations were performed due to clinical suspicion of dysfunction. Angiography and PTA were made when suitable according to guidelines. In 171 of these examinations no intervention was performed. Cases versus controls had lower access flow (599±442 vs 1140±523, p<0.001), blood pump speed (291±49 vs 313±34, p<0.001), PTH (31±39 vs 39±29 pmol/L, p=0,021), Ca-phosphate product (3.9±1.1 vs 4.2±1.0, p=0.025), C-reactive protein (17±25 vs 24±38, p=0.004) and, higher in regard to recirculation (5.1±11 vs 0.5±3.4, p<0.001), HbA1c (52±16 vs 47±17, p=0.027), dose of tinzaparin (14330±8000 vs 12743±5400U/week, p= 0.025), weekly dose of erythropoietin stimulating agent (ESA, 8900±7100 vs 4900±4600U/week, p<0,001), and higher weekly iron supplement dosing (60±61 vs 41±54mg/week, p<0.001). Alfa- and Beta-blockers against hypertension were more often used among cases.
Conclusion
The reason for AVF problems in cases showed limited disturbances in Ca-phosphate hemostasis and inflammation. Instead, it seems that higher dosing of ESA and LMWH (as indicator of clotting) are factors that could be associated with development of AVF malfunction.
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Affiliation(s)
- Anna Vb Wã¤rme
- Institution of medicine, Department of internal medicine and clinical nutrition, Sweden
| | - Bernd Stegmayr
- , Department of Public Health and Clinical Medicine,, Umeå, Sweden
| | - Salmir Nasic
- , Research and Development Centre, FOU, Skövde, Sweden
| | - Henrik Hadimeri
- Institute of Medicine, Department of internal medicine and clinical nutrition, Gothenburg, Sweden
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Peters B, Mölne J, Nasic S, Felldin M, Mjörnstedt L, Stegmayr B. P1657GRAFT- AND PATIENT-SURVIVAL IN TRANSPLANT KIDNEY PATIENTS UNDERGOING TRANSPLANT BIOPSIES. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background and Aims
Kidney transplantation is a frequent treatment in uremic patients. However, long term patency is limited. The aim of this study was to investigate the histological findings in transplant biopsies in relation to clinical outcome in patients.
Method
1542 patients (36.4 % women) were included if they had a first kidney transplant registered in a quality assessment registry (period October 24, 1968 and August 28, 2017) and also had registered a first transplant kidney biopsy during the period January 1, 2007 until Mars 2, 2018. Graft- and patient-survival analysis was performed by Kaplan-Meier- and Cox-regression-analysis (adjusted for age and gender). Data are presented as Hazard Ratio (HR) and 95% Confidence Intervals (CI). A two-sided p-value of <0.05 was considered as statistically significant.
Results
Patients with primary and recurrent glomerulonephritis (GN) found in the biopsy had a worse graft- (70% at 5-year) and patient-survival (85% at 5-year) compared to all other diagnoses (p<0.05). Comparing with GN as reference group with respect to graft-loss the risk was lower if biopsies revealed infections (HR 0.3, CI 0.1-0.9), chronic damages (HR 0.38, CI 0.2-0.6), CNI-toxicity (HR 0.3, CI 0.2-0.6) or rejection (HR 0.5, CI 0.3-0.9). Looking at patient-survival, compared to those with GN a lower risk for early death was found for those with tubulointerstitial diseases (HR 0.35, CI 0.1-0.9), chronic damages (HR 0.35, CI 0.2-0.7), CNI-toxicity (HR 0.4, CI 0.2-0.9) and rejection (HR 0.4, CI 0.2-0.9) while those with hematological diseases (HR 14, CI 3.7-53.6) had higher risk for early death. Comparing subgroups within rejections, there was a significant (p<0.01) better graft-survival in patients with cellular rejection or borderline changes (90% at 5-year) versus those with humoral (65% at 5-year), chronic humoral and cellular rejection (60% at 5-year), and transplant-glomerulopathy (TGP) (70% at 5-year). The patient-survival was worse for patients with a TGP (70% at 5-year) compared to cellular rejections (p=0.04). Patients with humoral (HR 4.4, CI 2.3-8.4), chronic humoral and cellular rejection (HR 5.8, CI 2.9-9.9) and TGP (HR 3.7, CI 1.6-8.8) had higher risk for graft-loss and patients with TGP (HR 3.5, CI 1.2-10.5) had higher risk for early death compared to cellular rejection as reference. In addition, it was found that the median time between the graft-loss and death (25 patients) was 76 days (mean 304 days) and 44% of these patients died within 30 days after graft-loss. The median age of these patients was 62 years. Between the patients who died within 30 days and the others, no differences were found in cause of death, findings in the transplant kidney biopsies or type of transplant kidney (living versus deceased).
Conclusion
Patients with GN and patients with TGP had a worse outcome in both graft- and patient-survival. Awareness should focus on the patients who die soon after graft-loss.
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Affiliation(s)
- Björn Peters
- Skaraborg Hospital, Nephrology, Skövde, Sweden
- Umeå University, Public Health and Clinical Medicine, Umeå, Sweden
| | - Johan Mölne
- Sahlgrenska University Hospital, Pathology, Gothenburg, Sweden
| | - Salmir Nasic
- Skaraborg Hospital, Research Center (FoU), Skövde, Sweden
| | - Marie Felldin
- Sahlgrenska University Hospital, Transplantation Center, Gothenburg, Sweden
| | - Lars Mjörnstedt
- Sahlgrenska University Hospital, Transplantation Center, Gothenburg, Sweden
| | - Bernd Stegmayr
- Umeå University, Public Health and Clinical Medicine, Umeå, Sweden
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Afghahi H, Nasic S, Alhomsi K, Hadimeri H, Rydell H, Svensson J. P1159MILD BLOOD PRESSURE VARIABILITY IS ASSOCIATED WITH BETTER SURVIVAL IN PATIENTS WITH END STAGE RENAL DISEASE AND PERITONEAL DIALYSIS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Recently, variability in blood pressure (BP) has been recognized as a risk factor for mortality and cardiovascular events in the general population. However, most studies included patients with normal or near normal kidney function.
Aim
To study the association between BP variability and the risk of all-cause mortality in patients with end stage renal disease (ESRD) and peritoneal dialysis (PD) treatment.
Method
From 2008 until the end of 2017, 2329 patients with ESRD and at least three months of PD (mean age: 63.8 years, men: 67.5%) were followed for 16 months in median (interquartile range: 11-28 months). Data were extracted from the Swedish Renal Register (SNR).
The coefficient variation (CV = the ratio of the standard deviation (SD) to the mean value) was defined as BP variability in terms of systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) [SBP(SD)/SBP(mean), DBP(SD)/ DBP(mean), and MAP(SD)/MAP(mean), respectively].
The relationships between BP variability and mortality were examined by time-dependent Cox models to estimate hazard ratios (HR) and 95% confidence intervals (CI) in univariate and multivariate analyses, with adjustment for demographics, laboratory findings and comorbidity.
Results
During the follow-up period, 1054 (45%) deaths occurred. The mean level of BP variability was CV=0.10± 0.1.
The highest rate of mortality was observed in the patients with the highest variability in SBP (CV>0.25; 64% of those patients died).
In the multivariate model, for each of the BP variables, we compared the risk of mortality in the lowest variability group (CV≤ 0.05) with that in the CV=0.10-0.15 group (reference):
SBP: (HR 1.74, 95% CI 1.44- 2.09; p<0.001); DBP: (HR 1.91, 95% CI 1.59- 2.23; p<0.001); and MAP: (HR 1.73, 95% CI 1.44- 2.06; p<0.001). Thus, for all BP variables, the lowest variability was associated with increased mortality risk.
We then compared the highest variability group (CV>0.25) with the CV=0.10-0.15 group (reference):
SBP: (HR 1.60, 95% CI 1.14- 2.25; p<0.001); DPB: (HR 1.74, 95% CI 1.44- 2.09; p<0.001); and MAP: (HR 1.98, 95% CI 1.21- 3.27; p<0.001). Thus, for all BP variables, the highest variability was related to increased mortality risk.
Conclusion
In this study, the association between BP variability and the risk of mortality was U-shaped in patients with ESRD and PD. Thus, both very low and high levels of BP variability were related to higher risk of mortality. Mild BP variability was associated with the lowest risk of mortality, which could suggest that, non-intensive and long duration of ultrafiltration (UF) with PD was probably beneficial in terms of survival
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Affiliation(s)
- Hanri Afghahi
- Skaraborg Hospital, Department of Nephrology, Skövde, Sweden
- Skaraborg Hospital, Department of Nephrology, Skövde, Sweden
| | - Salmir Nasic
- Skaraborg Central Hospital, Department of research and development, Skövde, Sweden
| | - Khaled Alhomsi
- Skaraborg Hospital, Department of Nephrology, Skövde, Sweden
| | - Henrik Hadimeri
- Skaraborg Hospital, Department of Nephrology, Skövde, Sweden
| | - Helena Rydell
- Karolinska University Hospital, Department of Nephrology, Stockholm, Sweden
| | - Johan Svensson
- Skaraborg Central Hospital, Department of research and development, Skövde, Sweden
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Afghahi MD H, Nasic S, Alhomsi K, Rydell H, Hadimeri H, Svensson J. SAT-268 IN PATIENTS WITH DIABETES AND END STAGE RENAL DISEASE, ASSOCIATION BETWEEN BODY MASS INDEX AND RISK OF MORTALITY IS DIFFERENT IN HEMODIALYSIS AND PERITONEAL DIALYSIS. Kidney Int Rep 2020. [DOI: 10.1016/j.ekir.2020.02.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Waldén K, Jeppsson A, Nasic S, Karlsson M. Fibrinogen Concentrate to Cardiac Surgery Patients with Ongoing Bleeding does not Increase the Risk of Thromboembolic Complications or Death. Thromb Haemost 2020; 120:384-391. [DOI: 10.1055/s-0039-3402759] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Background We investigated whether fibrinogen concentrate administration to bleeding patients is associated with an increased risk of thromboembolic complications and death.
Methods All consecutive patients who underwent first-time cardiac surgery at Sahlgrenska University Hospital from 2009 to 2014 were included. Patients, who had received fibrinogen concentrate, were compared with those who had not received fibrinogen concentrate. The primary endpoint was a composite of thromboembolic complications and death within 1 year after surgery. Secondary endpoints included the composite and mortality within 30 days and mortality within 1 year after surgery. Multivariable logistic regression and Cox regression models were used to compare the groups. Propensity score (PS)-matched models were used for sensitivity analyses.
Results A total of 5,408 patients were included in the present study, of which 564 (10.4%) received fibrinogen concentrate. The composite endpoint occurred in 3.5% of patients at 30 days and 10.5% at 1 year. There was no significant difference between the groups in the composite endpoint at 1 year (adjusted hazard ratio [HR]: 1.11, 95% confidence interval [CI]: 0.84–1.46, p = 0.45) or in the secondary endpoints, that is, mortality at 1 year (adjusted HR: 1.38, 95% CI: 0.93–2.04, p = 0.11), composite at 30 days (adjusted odds ratio [OR]: 1.07, 95% CI: 0.64–1.81, p = 0.79) and mortality at 30 days (adjusted OR: 1.00, 95% CI: 0.51–1.96, p = 0.50). The results of the sensitivity analyses were consistent with those of main analyses.
Conclusion Perioperative administration of fibrinogen concentrate to bleeding cardiac surgery patients is not associated with an increased risk of thromboembolic complications or death.
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Affiliation(s)
- Katarina Waldén
- Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital Östra, Gothenburg, Sweden
- Department of Anaesthesia and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Salmir Nasic
- Department of Biostatistics, Research and Development, Skaraborg Hospital, Skövde, Sweden
| | - Martin Karlsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Skaraborg Hospital, Lidköping, Sweden
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Sarenmalm EK, Nasic S, Håkanson C, Öhlén J, Carlsson E, Pettersson ME, Sawatzky R. Swedish Version of the Distress Thermometer: Validity Evidence in Patients With Colorectal Cancer. J Natl Compr Canc Netw 2019; 16:959-966. [PMID: 30099372 DOI: 10.6004/jnccn.2018.7027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 03/19/2018] [Indexed: 11/17/2022]
Abstract
Background: The objective of this study was to validate the NCCN Distress Thermometer (DT), including the accompanying Problem List (PL), in a Swedish population of patients diagnosed with colorectal cancer (CRC). Methods: A total of 488 patients diagnosed with CRC completed the DT/PL and EORTC core quality-of-life questionnaire (QLQ-C30) before surgery. Construct validity of the PL was analyzed using a confirmatory factor analysis. Internal consistency reliability (ICR) was tested using Cronbach's alpha coefficient. Correlations between the reported PL areas and QLQ-C30 function scales were used to explore convergent validity. Discriminant validity was examined by evaluating associations between the DT and QLQ-C30 measures of overall health-related quality of life (HRQoL). Results: Findings showed that the Swedish translation of the DT/PL is consistent with the original English version. The DT has good ICR, with the total number of reported problems significantly correlating with DT scores (r=0.67; P<.001). Analysis of convergent validity indicated that the PL areas significantly correlated with QLQ-C30 function scales, with emotional problems showing the highest correlation (r=0.76; P<.001), and item-level correlation analyses showed significant correlations between symptoms. There was also good discriminant validity between the DT and the QLQ-C30 in terms of HRQoL, including overall health status (r=-0.49; P<.001) and overall quality of life (r=-0.57; P<.001). Furthermore, there was good discriminant validity between the DT and QLQ-C30 regarding poor, moderate, and excellent HRQoL. Conclusions: These findings provide validity evidence regarding the DT, including the PL. Findings also show that the DT has good potential for screening distress-related practical, family, emotional, and physical problems during the cancer trajectory in Swedish-speaking patients. Additionally, the DT seems to be an effective screening tool to detect patients with poor, moderate, and excellent HRQoL.
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Peters B, Nasic S, Segelmark M. Clinical parameters predicting complications in native kidney biopsies. Clin Kidney J 2019; 13:654-659. [PMID: 32905412 PMCID: PMC7467621 DOI: 10.1093/ckj/sfz132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 05/13/2019] [Accepted: 08/27/2019] [Indexed: 01/26/2023] Open
Abstract
Background Renal biopsies are essential in nephrology but they are invasive and complications can occur. The aim of this study was to explore clinical parameters that can be used as predictors for biopsy complications. Methods Clinical parameters such as demographics, biopsy indications, serology, comorbidities and clinical chemistry were retrieved from a regional biopsy registry between 2006 and 2015 and from a nationwide registry between 2015 and 2017. Clinical data before biopsy were compared with data on major biopsy complications. Fisher’s exact and χ2 tests were used and odds ratios (ORs) with 95% confidence intervals (CIs) were presented. Univariate and multiple binary logistic regression analyses were performed with complications as outcome. A two-sided P-value <0.05 was considered significant. Results In total, 2835 consecutive native kidney biopsies were analysed (39% women and 61% men, median age 57 years). No death and nephrectomy due to biopsy complications were registered. The frequency of major biopsy complications was 5.65%. In the multiple logistic regression, the risk for complications increased in women [OR 1.51 (95% CI 1.08–2.11)] and decreased with age: 45–64 years age group [OR 0.66 (95% CI 0.44–0.99)] and >74 years age group [OR 0.51 (95% CI 0.27–0.96)]. Among comorbidities, patients with diabetes mellitus type 2 [OR 2.07 (95% CI 1.15–3.72)] and non-ischaemic heart disease [OR 3.20 (95% CI 1.64–6.25)] had a higher risk for major biopsy complications. Conclusions Female gender, younger age (≤44 years), diabetes mellitus type 2 and non-ischaemic heart disease were found as risk factors for major biopsy complications.
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Affiliation(s)
- Björn Peters
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden.,Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
| | - Salmir Nasic
- Research and Development Centre (FoU) at Skaraborg Hospital, Skövde, Sweden
| | - Mårten Segelmark
- Department of Clinical Sciences, Nephrology, Lund University, Lund, Sweden
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Bergqvist GM, Nasic S, Persson CU. Authors' response. Top Stroke Rehabil 2019; 27:159. [PMID: 31613708 DOI: 10.1080/10749357.2019.1663675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Gunilla M Bergqvist
- Department of Occupational and Physiotherapy Unit, Skaraborg Hospital Skövde, Skövde, Sweden
| | - Salmir Nasic
- Department of Research and Development Centre, Skaraborg Hospital Skövde, Skövde, Sweden
| | - Carina U Persson
- Department of Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Physiotherapy/Östra, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Hadimeri U, Wärme A, Nasic S, Fransson SG, Wigelius A, Stegmayr B. Angiography and phlebography in a hemodialysis population: A retrospective analysis of interventional results. Int J Artif Organs 2019; 42:675-683. [PMID: 31303134 PMCID: PMC6826886 DOI: 10.1177/0391398819863429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To clarify the reasons and beneficial effects and duration of arteriovenous fistula patency after radiological interventions in arteriovenous fistula. The patients investigated were referred due to arteriovenous fistula access flow problems. MATERIAL AND METHODS In 174 patients, 522 radiological investigations and endovascular treatments such as percutaneous transluminal angioplasty were analyzed, retrospectively. All investigations were performed due to clinical suspicion of impaired arteriovenous fistula function. RESULTS Arterial stenosis was significantly more frequent among patients with diabetic nephropathy (p < 0.001) and interstitial nephritis (p < 0.001). According to the venous stenosis, the diagnosis did not affect the frequency (p = 0.22) or the degree (p = 0.39) of stenosis. The degree of stenosis prior to percutaneous transluminal angioplasty correlated significantly with the degree of remaining stenosis after intervention (p < 0.001). Of the 174 patients, 123 (71%) performed a total of 318 investigations including percutaneous transluminal angioplasty. Repeated percutaneous transluminal angioplasty was performed significantly more often in patients with diabetic nephropathy. The median times to the first percutaneous transluminal angioplasty and to the subsequent percutaneous transluminal angioplasties were 9.5 and 5 months, respectively. Arteriovenous fistula in patients with diabetic nephropathy performed similar to most other diagnoses, although performing more percutaneous transluminal angioplasty/patient than most other diagnoses. CONCLUSION Many patients could maintain long-term patency of arteriovenous fistula, including those with diabetic nephropathy, with repeated interventions; this motivates a closer follow-up for these patients. Clinically significant stenosis should be dilated as meticulously and as soon as possible. Occlusions of the arteriovenous fistula in most instances can be successfully thrombolyzed or dilated upon early diagnosis.
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Affiliation(s)
- Ursula Hadimeri
- Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden.,Department of Radiology, Skaraborg Hospital, Skövde, Sweden
| | - Anna Wärme
- Department of Internal Medicine and Clinical Nutrition, Institution of Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
| | - Salmir Nasic
- Department of Research and Development, Skaraborg Hospital, Skövde, Sweden
| | - Sven-Göran Fransson
- Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden.,Department of Radiology, Linkoping University, Linkoping, Sweden
| | - Ann Wigelius
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Bernd Stegmayr
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Abstract
OBJECTIVES Data on the long-term time course of poststroke functional outcome is limited. We investigated changes in functional outcome over 5 years after stroke in a hospital based cohort. MATERIALS AND METHODS Consecutive patients who were independent in activities of daily living (ADL) and admitted to a Stroke Unit at Skaraborg Hospital, Sweden for a first acute stroke from 2007 to 2009 (n = 1,421) were followed-up after 3 months and thereafter annually over 5 years using a postal questionnaire. Clinical variables at acute stroke and 3 months post stroke were obtained from the Swedish Stroke Register. ADL dependency was defined as dependence in dressing, toileting or indoor mobility. RESULTS The proportions of survivors who reported ADL dependency remained stable throughout follow-up (19%-22%). However, among survivors who were ADL independent at 3 months, about 3% deteriorated to dependency each year. Deterioration was predicted by age (HR 1.11; 95% CI 1.08-1.13), diabetes (HR 1.65; 95% CI 1.12-2.44), NIHSS score (HR 1.07; 95% CI 1.04-1.10), and self-perceived unmet care needs one year post stroke (HR 2.01; 95% CI 1.44-2.81). Transitions from ADL dependency to independence occurred mainly during the first year post stroke. Improvement was negatively predicted by living alone before stroke (HR 0.41 95% CI 0.19-0.91), NIHSS score (HR 0.90; 95% CI 0.86-0.95) and ischemic stroke (vs. hemorrhagic stroke), HR 0.39; 95% CI 0.17-0.89. CONCLUSION Transitions between ADL independence and dependency occur up to 5 years after stroke. Some of the factors predicting these transitions are potentially modifiable.
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Affiliation(s)
- Åsa Rejnö
- Department of Medicine, Skaraborg Hospital Skövde, Skövde, Sweden.,Department of Health Sciences, University West, Trollhättan, Sweden
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital Skövde, Skövde, Sweden
| | - Kerstin Bjälkefur
- Department of Health and Social Care, Municipality of Lidköping, Sweden
| | - Eric Bertholds
- Department of Medicine, Skaraborg Hospital Skövde, Skövde, Sweden
| | - Katarina Jood
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Afghahi H, Nasic S, Rydell H, Hadimeri H, Alhomsi K, Svensson J. SaO059LONG TERM GLYCEMIC VARIABLITY AND THE RISK OF MORTALITY IN DIABETIC PATIENTS ON PERITONEAL DIALYSIS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz101.sao059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wärme A, Hadimeri U, Hadimeri H, Nasic S, Stegmayr B. High doses of erythropoietin stimulating agents may be a risk factor for AV-fistula stenosis. Clin Hemorheol Microcirc 2019; 71:53-57. [PMID: 29914013 DOI: 10.3233/ch-180381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A native AV-fistula (AVF) for access in hemodialysis (HD) is preferable. Stenosis, a major hurdle, is associated with older age and diabetes mellitus. PURPOSE This case-control study aimed to clarify if any medical and/or laboratory factors, that can be altered, could be associated to AVF stenosis. METHODS 33 patients with a patent AVF without need of intervention during a two year period (Controls) were matched by diagnosis and age with 33 patients (Cases), that had at least one radiological invasive examination/intervention due to suspected AVF malfunction (case-control mode 2:1). RESULTS Cases had higher weekly doses of Erythropoietin-Stimulating Agent (ESA) than Controls both before intervention (mean 8312±7119 U/w versus 4348±3790, p = 0.005) and after the intervention (7656±6795, versus 4477±3895, p = 0.018). Before intervention serum phosphate was higher in Cases while there was no significant difference in blood hemoglobin, weekly standard Kt/V, parathyroid hormone, calcium, albumin, C-reactive protein, smoking habits, BMI or other medication. CONCLUSION Higher doses of ESA were administered in patients with AVF stenosis. Since ESA may cause local hypertrophic effects on the vascular endothelium, we should prescribe lower doses of ESA in patients at risk. Further studies should clarify such connection.
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Affiliation(s)
- Anna Wärme
- Department of Internal Medicine and Clinical Nutrition, Institution of Medicine, University of Gothenburg, Sweden.,Skaraborg Hospital, Skövde, Sweden
| | - Ursula Hadimeri
- Skaraborg Hospital, Skövde, Sweden.,Department of Medical and Health Sciences, Linköping University, Sweden
| | - Henrik Hadimeri
- Department of Internal Medicine and Clinical Nutrition, Institution of Medicine, University of Gothenburg, Sweden.,Skaraborg Hospital, Skövde, Sweden
| | | | - Bernd Stegmayr
- Department of Nephrology, Public Health and Clinical Medicine, Umeå University, Sweden
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Bergqvist GM, Nasic S, Persson CU. Inter-rater reliability of the Swedish modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) in the acute phase after stroke. Top Stroke Rehabil 2019; 26:366-372. [PMID: 30983553 DOI: 10.1080/10749357.2019.1601911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Before implementation of the new scale, the Swedish modified version of the Postural Assessment Scale for Stroke Patients (SwePASS), to clinical practice, it is fundamental to analyze its measurement properties.Objective: To examine the inter-rater reliability of the SwePASS in the acute phase after stroke. Methods: Day 3 to day 7 after admission to a stroke unit, 64 persons with stroke were assessed twice, using the SwePASS, by two physiotherapists. Inter-rater reliability was determined using percentage-agreement and the rank-invariant method: relative position, relative concentration, and relative rank variance. Results: The raters showed a percentage agreement of ≥75% in the assessments using the SwePASS. For 9 of the 12 items, the percentage agreement was >80%. For 8 of the 12 items, there was a statistically significant change in position, revealed in relative position values between 0.08 and 0.15. Three items had statistically significant positive relative concentration values between -0.11 and 0.10. Except for a statistically significant negligible relative variance value of 0.01 for the items 1 and 8, there was no relative variance. Conclusions: The SwePASS shows an acceptable inter-rater reliability, albeit with potential for improvement. The reliability can be improved by a consensus how to interpret the scale between the raters prior to implementation in the clinic.
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Affiliation(s)
- Gunilla M Bergqvist
- a Department of Occupational and Physiotherapy Unit , Skaraborg Hospital Skövde , Skövde , Sweden
| | - Salmir Nasic
- b Department of Research and Development Centre , Skaraborg Hospital Skövde , Skövde , Sweden
| | - Carina U Persson
- c Department of Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden.,d Department of Physiotherapy/Östra, Region Västra Götaland , Sahlgrenska University Hospital , Gothenburg , Sweden
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Andersson JO, Nasic S, Herlitz J, Hjertonsson E, Axelsson C. The intensity of pain in the prehospital setting is most strongly reflected in the respiratory rate among physiological parameters. Am J Emerg Med 2019; 37:2125-2131. [PMID: 30718118 DOI: 10.1016/j.ajem.2019.01.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Received: 09/11/2018] [Revised: 01/07/2019] [Accepted: 01/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In order to treat pain optimally, the Emergency Medical Service (EMS) clinician needs to be able to make a reasonable estimation of the severity of the pain. It is hypothesised that various physiological parameters will change as a response to pain. AIM In a cohort of patients who were seen by EMS clinicians, to relate the patients' estimated intensity of pain to various physiological parameters. METHODS Patients who called for EMS due to pain in a part of western Sweden were included. The intensity of pain was assessed according to the visual analogue scale (VAS) or the Numerical Rating Scale (NRS). The following were assessed the same time as pain on EMS arrival: heart rate, systolic and diastolic blood pressure, respiratory rate, moist skin and paleness. RESULTS In all, 19,908 patients (≥18 years), were studied (51% women). There were significant associations between intensity of pain and the respiratory rate (r = 0.198; p < 0.0001), heart rate (r = 0.037; p < 0.0001), systolic blood pressure (r = -0.029; p < 0.0001), moist skin (r = 0.143; p < 0.0001) and paleness (r = 0.171; p < 0.0001). The strongest association was found with respiratory rate among patients aged 18-64 years (r = 0.258; p < 0.0001). CONCLUSION In the prehospital setting, there were significant but weak correlations between intensity of pain and physiological parameters. The most clinically relevant association was found with an increased respiratory rate and presence of pale and moist skin among patients aged < 65 years. Among younger patients, respiratory rate may support in the clinical evaluation of pain.
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Affiliation(s)
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
| | - Johan Herlitz
- University of Borås, Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work, Life and Social Welfare, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden.
| | | | - Christer Axelsson
- University of Borås, Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work, Life and Social Welfare, Sweden.
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Nolskog P, Backhaus E, Nasic S, Enroth H. STI with Mycoplasma genitalium-more common than Chlamydia trachomatis in patients attending youth clinics in Sweden. Eur J Clin Microbiol Infect Dis 2018; 38:81-86. [PMID: 30327896 DOI: 10.1007/s10096-018-3395-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 07/12/2018] [Accepted: 10/01/2018] [Indexed: 11/30/2022]
Abstract
The prevalence of Chlamydia trachomatis in Sweden is well known, whereas the prevalence of Mycoplasma genitalium is less well documented. Youth clinics offer free contraception advice, sexually transmitted infection (STI) testing and/or contact tracing for the age group 15-25 years. The main objective of this study was to determine the prevalence of STIs, the presence of symptoms and the role of contact tracing. From July 2013 to March 2014, 1001 persons, 509 women and 492 men, were included in this study of six youth clinics in the Region of Västra Götaland. Symptoms were registered and whether the patient was tested because of contract tracing. Collection of urine samples, testing, treatment and disease registration were performed according to clinical routines. Urine samples were analysed for C. trachomatis/N. gonorrhoeae on the Cobas 4800 system (Roche). M. genitalium was analysed by lab-developed PCR. Genital infection was present in 16.8%. The prevalence of M. genitalium was higher than for C. trachomatis (9.6% and 7.1%). Men with symptoms have a significantly higher relative risk for infection with M. genitalium or C. trachomatis compared to asymptomatic men, while there is no increase for women. Contact tracing is important since positive outcome has a high relative risk for both infections. The prevalence of M. genitalium was higher than C. trachomatis in this study population. Initial testing for both C. trachomatis and M. genitalium should at least be considered for young men presenting with symptoms of genital infection. In finding positive cases, contact tracing is of great importance.
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Affiliation(s)
- Peter Nolskog
- Department of Communicable Disease Control and Prevention, Region of Västra Götaland, Skaraborg Hospital, 541 85, Skövde, Sweden.
| | - Erik Backhaus
- Department of Infectious Diseases, Skaraborg Hospital, Skövde, Sweden
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden
| | - Helena Enroth
- Clinical molecular microbiology, Laboratory Medicine, Unilabs, Skövde, Sweden.,Systems Biology Research Group, School of Biosciences, University of Skövde, Skövde, Sweden
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Peters B, Hadimeri H, Mölne J, Nasic S, Jensen G, Stegmayr B. Desmopressin (Octostim®) before a native kidney biopsy can reduce the risk for biopsy complications in patients with impaired renal function: A pilot study. Nephrology (Carlton) 2018; 23:366-370. [PMID: 28107603 DOI: 10.1111/nep.13004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 01/03/2017] [Revised: 01/12/2017] [Accepted: 01/17/2017] [Indexed: 12/20/2022]
Abstract
AIM To evaluate whether the administration of desmopressin alters the risk for renal biopsy complications. METHODS A multicenter registry containing 576 native kidney biopsies (NKb) with a serum creatinine above 150 μmol/L in 527 patients (372 men and 155 women, median age 61 years) was used. Most of the data were prospective. At one of the hospitals all biopsies with creatinine above 150 μmol/L received desmopressin before biopsies (NKb 204). These were compared to outcome of biopsy complications against other centres where desmopressin was not given (NKb 372). Fisher's exact test, χ2 analyses, univariate and multiple binary logistic regression were used. Data were given as odds ratio (OR) and confidence interval (CI). A two sided P-value of <0.05 was considered significant. RESULTS In NKb with creatinine >150 μmol/L, those with desmopressin had less overall (3.4% vs 8.4%, OR 0.39, CI 0.17-0.90) whereas major or minor complications were not different. While desmopressin did not exhibit difference in complications in men, women received less major (0% vs 8.6%, P = 0.03) and overall complications (0% vs 12.1%, P = 0.006). A multiple logistic regression revealed that, after adjusting for BMI, age and sex, prophylaxis with desmopressin showed less major (OR 0.38, CI 0.15-0.96) and overall complications (OR 0.36, CI 0.15-0.85). CONCLUSION Desmopressin given before a native kidney biopsy in patients with impaired renal function can reduce the risk for complications.
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Affiliation(s)
- Björn Peters
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden.,Department of Public Health and Clinical Medicine, Umeå University, Gothenburg, Sweden
| | - Henrik Hadimeri
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
| | - Johan Mölne
- Department of Pathology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Salmir Nasic
- Department of Research Center (FoU), Skaraborg Hospital, Skövde, Sweden
| | - Gert Jensen
- Department of Nephrology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bernd Stegmayr
- Department of Public Health and Clinical Medicine, Umeå University, Gothenburg, Sweden
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Lundh S, Nasic S, Riad J. Fatigue, quality of life and walking ability in adults with cerebral palsy. Gait Posture 2018; 61:1-6. [PMID: 29277025 DOI: 10.1016/j.gaitpost.2017.12.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/12/2017] [Accepted: 12/15/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Few studies on fatigue, quality of life and walking ability in adults with cerebral palsy (CP) are available. It is unclear whether these variables are associated. AIM The aim was to study the influence of CP on fatigue, quality of life, and gait of adult patients. MATERIAL AND METHODS Three-dimensional gait analysis was performed on 24 women and 26 men, mean age 32.1 (range 21.7-67.2), 23 with unilateral and 27 with bilateral CP. The Gait Profile Score was calculated; Fatigue Severity and EQ Visual Analogue scales were used. RESULTS Fatigue severity was higher than in controls, mean 3.8 (SD 1.8) vs 3.0 (p = 0.012). Fatigue in the unilateral group was 3.3 (SD 1.8) and in the bilateral 4.2 (SD 1.7), (p = 0.07). EQ Visual Analogue scale in the unilateral group was mean 79.5 (21.9) and in the bilateral 64.0 (20.8), p = 0.007. The group with bilateral CP tended toward crouch gait, decreased balance and low walking speed. Muscle work was shifted from the ankle to hip muscles. Fatigue correlated with the Gait Profile Score, CC = 0.31 (p = 0.038), and with knee flexion deviation, CC = 0.31 (p = 0.037). DISCUSSION Crouch gait, increased knee flexion in stance, contributes to increased deviation in the lower extremity associated with high fatigue and low quality of life in adults with CP, effects more pronounced in those with bilateral CP. Compensation mechanisms in gait were noted. CONCLUSION Rational follow-up programs for CP, ideally identifying risk factors early, should be established to prevent development of fatigue and deterioration of gait in adulthood.
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Affiliation(s)
- Sofia Lundh
- Skaraborg Gait Analysis Laboratory, Skaraborg Hospital Skövde, 541 85 Skövde, Sweden.
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital Skövde, 541 85 Skövde, Sweden.
| | - Jacques Riad
- Dept Orthopaedics, Skaraborg Hospital Skövde, 541 85 Skövde, Sweden.
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Bohman A, Oscarsson M, Holmberg K, Johansson L, Millqvist E, Nasic S, Bende M. Relative frequencies of symptoms and risk factors among patients with chronic rhinosinusitis with nasal polyps using a case-control study. Acta Otolaryngol 2018; 138:46-49. [PMID: 28826302 DOI: 10.1080/00016489.2017.1366052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the relative frequency of important symptoms of chronic rhinosinusitis with nasal polyps (CRSwNP), the link between CRSwNP and the lower airways and the importance of smoking in CRSwNP. METHOD Three hundred and sixty-eight patients with CRSwNP and 1349 controls were recruited to the study and underwent a structured interview about symptoms from the upper and lower airways, and about smoking habits. Furthermore, all participants were clinically examined using nasal endoscopy. RESULTS Due to interactions between the outcome variables, a multiple logistic regression model was fitted to the data. Nasal secretions, nasal blockage and impaired sense of smell were symptoms associated with CRSwNP. Furthermore, male gender, increasing age and asthma were also associated with the disease. Current smoking was less frequent among patients with CRSwNP. CONCLUSION By comparing symptoms and risk factors of patients with CRSwNP with those of a large population-based control group and testing them in a multiple logistic regression model, we have been able to generate data that address key research interests in CRSwNP.
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Affiliation(s)
- Anton Bohman
- Department of Otorhinolaryngology, Uppsala University Hospital, Uppsala, Sweden
| | - Martin Oscarsson
- Department of Otorhinolaryngology, Skaraborg Hospital, Skövde, Sweden
| | - Kenneth Holmberg
- Department of Otorhinolaryngology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Leif Johansson
- Department of Otorhinolaryngology, Skaraborg Hospital, Skövde, Sweden
| | - Eva Millqvist
- Department of Internal Medicine/Respiratory Medicine and Allergology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden
| | - Mats Bende
- Department of Otorhinolaryngology, Skaraborg Hospital, Skövde, Sweden
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Melkersson C, Nasic S, Starzmann K, Bengtsson Boström K. Effect of Foot Manipulation on Pregnancy-Related Pelvic Girdle Pain: A Feasibility Study. J Chiropr Med 2017; 16:211-219. [PMID: 29097951 DOI: 10.1016/j.jcm.2017.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/08/2016] [Accepted: 05/10/2017] [Indexed: 01/13/2023] Open
Abstract
Objective The objective of this study was to investigate if the research process to evaluate the effect of foot manipulation on pregnancy-related pelvic girdle pain (PPGP) is feasible. Methods A randomized, single-blind (patients and evaluators) pilot trial was performed to compare foot manipulation to a comparative group at 6-weekly treatment sessions at 5 physiotherapy outpatient clinics in Skaraborg primary care (Skövde, Sweden). Women at 12 to 31 weeks of pregnancy with well-defined PPGP (n = 97) and joint dysfunction or decreased range of movement in the feet were included. Women with a twin pregnancy, low back pain, rheumatoid arthritis, or other serious diseases and those who had previous foot manipulation were excluded. Visual analog scale scores were recorded before study start, before and after each treatment session, and 3 months after delivery. Results One-hundred and two women were eligible, and 97 were included (group 1: foot manipulation, n = 47; group 2: comparative treatment, n = 50); 40 and 36 in the foot manipulation and comparative treatment groups, respectively, completed the study. The foot manipulation group had a nonsignificant pain relief score compared with that of the comparative group, which had higher pain relief scores. The difference was most pronounced at the first and second treatment sessions. A power analysis showed that at least 250 individuals would be needed in each group to confirm the effect of foot manipulation. Conclusions This study showed that it is feasible to assess the effect of foot manipulation on PPGP in a multicenter physical therapy outpatient clinic setting. A new larger study should choose a different comparative method and test this hypothesis in a full-scale trial.
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Affiliation(s)
| | - Salmir Nasic
- Närhälsan, R&D Centre, Skaraborg Primary Care, Skövde, Sweden
| | - Karin Starzmann
- Närhälsan, R&D Centre, Skaraborg Primary Care, Skövde, Sweden
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Peters B, Hadimeri H, Mölne J, Nasic S, Jensen G, Stegmayr B. TO039DESMOPRESSIN BEFORE A NATIVE KIDNEY BIOPSY CAN REDUCE THE RISK FOR BIOPSY COMPLICATIONS IN PATIENTS WITH IMPAIRED RENAL FUNCTION. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx134.to039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Afghahi H, Nasic S, Hadimeri H. MP391RISK FACTORS ASSOCIATED WITH RAPID DECLINE OF RENAL FUNCTION IN PATEINTS WITH ADVANCE CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx170.mp391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Landgren M, Nasic S, Johnson M, Lövoll T, Holmgren D, Fernell E. Blood pressure and anthropometry in children treated with stimulants: a longitudinal cohort study with an individual approach. Neuropsychiatr Dis Treat 2017; 13:499-506. [PMID: 28243103 PMCID: PMC5317316 DOI: 10.2147/ndt.s123526] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Knowledge about the long-term effects on blood pressure (BP) and body mass index (BMI) when treating young patients for attention-deficit/hyperactivity disorder (AD/HD) with stimulants is limited. Most of the studies have reported mean and not individual values for anthropometrics and BP in treatment with stimulants. This seems to be the first study of changes based on the analyses of individual data measured over time. PATIENTS AND METHODS Seventy young patients (aged 8-18 years) diagnosed with AD/HD and responding well to treatment with stimulants were followed for a mean period of 3 years and 3 months. BP, heart rate, height, weight, and BMI were transformed to standard deviations or z-scores from before treatment to the last registered visit. RESULTS The mean dose of methylphenidate was 0.95 mg/kg. The mean increase of systolic and diastolic BP was 0.4 z-score and 0.1 z-score, respectively. The systolic BP was associated with BMI; a higher BMI at baseline increased the risk for an increase in systolic BP. Ten percent of the total group had a weight at follow-up of <-1.5 standard deviation (SD) and 12% had a height of <-1.5 SD. Mean height at follow-up was -0.2 SD, but 40% had a reduced height of at least 0.5 SD during the treatment period. BMI on a group level was reduced from +0.8 SD to +0.3 SD. Of the 19 patients with a BMI >+1.5 SD at baseline, 50% had a significantly reduced BMI. CONCLUSION Consequences of stimulant treatment must be evaluated individually. Besides significant effects on core AD/HD symptoms, some patients have lower BMI and BP and some increase/maintain their BMI and/or increase their systolic BP. The risk of reduced height trajectory needs further research.
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Affiliation(s)
- Magnus Landgren
- Department of Pediatrics, Unit of Developmental Disorders, Skaraborg's Hospital, Mariestad; Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg
| | | | - Mats Johnson
- Department of Pediatrics, Unit of Developmental Disorders, Skaraborg's Hospital, Mariestad; Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg
| | - Trygve Lövoll
- Department of Pediatrics, Unit of Developmental Disorders, Skaraborg's Hospital, Mariestad
| | - Daniel Holmgren
- Department of Pediatrics, Skaraborg's Hospital, Skövde; University of Gothenburg, Gothenburg, Sweden
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg
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Lindblad I, Nasic S, Landgren M, Svensson L, Gillberg C, Fernell E. Adaptive skills are useful for evaluating the effect of pharmacological treatment in children with attention-deficit/hyperactivity disorder. Acta Paediatr 2017; 106:96-100. [PMID: 27743498 DOI: 10.1111/apa.13631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/24/2016] [Accepted: 10/12/2016] [Indexed: 11/30/2022]
Abstract
AIM There are few long-term studies of adaptive functions as an outcome measure of pharmacological treatment in attention-deficit/hyperactivity disorder (ADHD). This study assessed the adaptive abilities of children with ADHD before and after several years of pharmacological treatment. METHOD We studied 12 children with a mean age of 15 years - seven boys and five girls - who had continued pharmacological treatment for ADHD for more than four years. The Adaptive Behaviour Assessment Scales - Second Edition ratings by their teachers were compared before and after they had received treatment for ADHD. RESULTS On a group level, the conceptual, practical and general adaptive composite domains improved significantly between the baseline and follow-up study. There were clear individual variations: more than half of the group increased from an adaptive level far below average to average, a minority displayed no major changes, and one individual deteriorated. The girls tended to have better outcomes than the boys. CONCLUSION This study was nonrandomised and only analysed within-group changes in a small number of participants. However, the findings suggest that four to five years of stimulant treatment had markedly positive effects on adaptive functioning in more than half of the school-age children with ADHD.
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Affiliation(s)
- Ida Lindblad
- Gillberg Neuropsychiatry Centre; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Salmir Nasic
- Research and Development Centre; Skaraborg's Hospital; Skövde Sweden
| | - Magnus Landgren
- Gillberg Neuropsychiatry Centre; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Unit of Developmental Disorders; Skaraborg's Hospital; Mariestad Sweden
| | - Leif Svensson
- Unit of Developmental Disorders; Skaraborg's Hospital; Mariestad Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Browall M, Brandberg Y, Nasic S, Rydberg P, Bergh J, Rydén A, Xie H, Eriksson I, Wengström Y. A prospective exploration of symptom burden clusters in women with breast cancer during chemotherapy treatment. Support Care Cancer 2016; 25:1423-1429. [PMID: 27981366 PMCID: PMC5378737 DOI: 10.1007/s00520-016-3527-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 08/23/2016] [Accepted: 12/05/2016] [Indexed: 11/03/2022]
Abstract
PURPOSE The aim was to prospectively map symptom clusters in patients with stage I-IIIa breast cancer during standard chemotherapy treatment in a randomised study. METHODS Participants completed the Memorial Symptom Assessment Scale (MSAS) at baseline, day 12 after the first and third cycle of FEC 75 or FEC 100, and day 12 after the last cycle of Taxotere. Cut-off values for symptom scores, a mean value based on each individual reporting a symptom including occurrence, frequency, severity and distress for inclusion in analysis, were determined. RESULTS The symptom burden cluster analysis was conducted in two steps and included symptoms with high frequency and high levels of distress. The factor analysis revealed three symptom clusters; physical, gastro (phys/gastro) and emotional, with core symptoms that remained stable over time. The most prevalent symptoms for the total sample during all cycles were as follows: lack of energy (range between 48 and 90%), feeling sad (48-79%), difficulty sleeping (54-78%), difficulty concentrating (53-74%), worrying (54-74%) and pain (29-67%). CONCLUSION In summary, we have prospectively established that symptom clusters remain stable over time with a basis of core symptoms. This knowledge will aid in the development of effective core symptom-focused interventions to minimise symptom burden for patients treated with chemotherapy for breast cancer.
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Affiliation(s)
- Maria Browall
- Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden. .,School of Health and Education, University of Skövde, Skövde, Sweden.
| | - Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden
| | - Per Rydberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Bergh
- Radiumhemmet and Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Rydén
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Hanjing Xie
- Radiumhemmet and Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Irene Eriksson
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Yvonne Wengström
- Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden.,Radiumhemmet and Cancer Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
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Backhaus E, Berg S, Andersson R, Ockborn G, Malmström P, Dahl M, Nasic S, Trollfors B. Epidemiology of invasive pneumococcal infections: manifestations, incidence and case fatality rate correlated to age, gender and risk factors. BMC Infect Dis 2016; 16:367. [PMID: 27487784 PMCID: PMC4972955 DOI: 10.1186/s12879-016-1648-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 06/07/2016] [Indexed: 11/17/2022] Open
Abstract
Background Incidence, manifestations and case-fatality rate (CFR) of invasive pneumococcal disease (IPD) vary with age and comorbidities. New vaccines, changing age distribution, prolonged survival among immunocompromised patients and improved sepsis management have created a need for an update of basic facts to inform vaccine recommendations. Methods Age, gender and comorbidities were related to manifestations and death for 2977 consecutive patients with IPD in a Swedish region with 1.5 million inhabitants during 13 years before introduction of pneumococcal conjugate vaccines (PCV) in the infant vaccination program. These data were related to population statistics and prevalence of several comorbidities, and compared with two previous studies giving a total follow-up of 45 years in the same area. Results The annual incidence was 15/100,000 for any IPD and 1.1/100,000 for meningitis; highest among elderly followed by children < 2 years. It was 2238/100,000 among myeloma patients, followed by chronic lymphatic leukemia, hemodialysis and lung cancer, but not elevated among asthma patients. CFR was 10 % among all patients, varying from 3 % below 18 years to 22 % ≥ 80 years. During 45 years, the IPD incidence increased threefold and CFR dropped from 20 to 10 %. Meningitis incidence remained stable (1.1/100,000/year) but CFR dropped from 33 to 13 %. IPD-specific mortality decreased among children <2 years from 3.1 to 0.46/100,000/year but tripled among those ≥65 years. Conclusions IPD incidence and CFR vary widely between age and risk groups and over time even without general infant vaccination. Knowledge about specific epidemiological characteristics is important for informing and evaluating vaccination policies.
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Affiliation(s)
- Erik Backhaus
- Department of Infectious Diseases, Skaraborg Hospital, 54185, Skövde, Sweden. .,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Stefan Berg
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Rune Andersson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Gunilla Ockborn
- Department of Infectious Diseases, Södra Älvsborg Hospital, Borås, Sweden
| | - Petter Malmström
- Department of Infectious Diseases, Norra Älvsborg Hospital, Trollhättan, Sweden
| | - Mats Dahl
- Department of Emergency Medicine, Kungälv Hospital, Kungälv, Sweden
| | - Salmir Nasic
- Research and Development Center, Skaraborg Hospital, Skövde, Sweden
| | - Birger Trollfors
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
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Johansson I, Andersson R, Friman V, Selimovic N, Hanzen L, Nasic S, Nyström U, Sigurdardottir V. Cytomegalovirus infection and disease reduce 10-year cardiac allograft vasculopathy-free survival in heart transplant recipients. BMC Infect Dis 2015; 15:582. [PMID: 26703239 PMCID: PMC4690411 DOI: 10.1186/s12879-015-1321-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 12/12/2015] [Indexed: 11/24/2022] Open
Abstract
Background Cytomegalovirus (CMV) is associated with an increased risk of cardiac allograft vasculopathy (CAV), the major limiting factor for long-term survival after heart transplantation (HTx). The purpose of this study was to evaluate the impact of CMV infection during long-term follow-up after HTx. Methods A retrospective, single-centre study analyzed 226 HTx recipients (mean age 45 ± 13 years, 78 % men) who underwent transplantation between January 1988 and December 2000. The incidence and risk factors for CMV infection during the first year after transplantation were studied. Risk factors for CAV were included in an analyses of CAV-free survival within 10 years post-transplant. The effect of CMV infection on the grade of CAV was analyzed. Results Survival to 10 years post-transplant was higher in patients with no CMV infection (69 %) compared with patients with CMV disease (55 %; p = 0.018) or asymptomatic CMV infection (54 %; p = 0.053). CAV-free survival time was higher in patients with no CMV infection (6.7 years; 95 % CI, 6.0–7.4) compared with CMV disease (4.2 years; CI, 3.2–5.2; p < 0.001) or asymptomatic CMV infection (5.4 years; CI, 4.3–6.4; p = 0.013). In univariate analysis, recipient age, donor age, coronary artery disease (CAD), asymptomatic CMV infection and CMV disease were significantly associated with CAV-free survival. In multivariate regression analysis, CMV disease, asymptomatic CMV infection, CAD and donor age remained independent predictors of CAV-free survival at 10 years post-transplant. Conclusions CAV-free survival was significantly reduced in patients with CMV disease and asymptomatic CMV infection compared to patients without CMV infection. These findings highlight the importance of close monitoring of CMV viral load and appropriate therapeutic strategies for preventing asymptomatic CMV infection.
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Affiliation(s)
- Inger Johansson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Rune Andersson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Vanda Friman
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Nedim Selimovic
- Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Lars Hanzen
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
| | - Ulla Nyström
- Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Vilborg Sigurdardottir
- Department of Cardiology, Swiss Cardiovascular Centre, University Hospital (Inselspital Bern) and University of Bern, Bern, Switzerland.
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Abstract
BACKGROUND Nasal polyps is a common disease but little is known about its` pathogenesis. Our hypothesis was that there are genetic factors involved in the development of this disease. The aim of this study was to examine close relatives of patients with nasal polyps and comparing them with a general population with regard to prevalence of polyps. METHODOLOGY Patients with nasal polyps who attended the clinic were recruited to the study and were asked whether they had any close adult relatives (siblings, parents or children). We intended to recruit two relatives per patient, one of each gender, for nasal endoscopy. The prevalence of nasal polyps in these relatives was compared with the prevalence of nasal polyps in a general population. RESULTS During a 4-year period, 368 patients and 410 relatives were recruited to the study. Although we were unable to recruit two close relatives for every patient, we were able to calculate nasal polyp prevalence within families as being 19.2%. Compared with the prevalence of nasal polyps among individuals in a general Swedish population from the same geographical area, the relative risk for polyps among relatives was almost five times higher. CONCLUSION This study strongly indicates that heredity is a factor of importance for development of nasal polyps.
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Johansson A, Ewertzon M, Andershed B, Anderzen-Carlsson A, Nasic S, Ahlin A. Health-related quality of life--from the perspective of mothers and fathers of adult children suffering from long-term mental disorders. Arch Psychiatr Nurs 2015; 29:180-5. [PMID: 26001718 DOI: 10.1016/j.apnu.2015.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 01/28/2015] [Accepted: 02/21/2015] [Indexed: 11/26/2022]
Abstract
There is a lack of studies on mothers' and fathers' experiences of Health-Related Quality of Life (HRQOL) associated with caregiving of adult children suffering from mental disorder. A cross-sectional study was therefore carried out with 108 mothers and 43 fathers. Data were collected by means of the Short Form Health Survey (SF-36), the Hospital Anxiety and Depression Scale (HADS), the Family Involvement and Alienation Questionnaire (FIAQ) and the Burden Assessment Scale (BAS). Mothers' HRQOL was affected more than fathers' and lower compared to Swedish age related norms. HRQOL was predominantly related to ratings on HADS and BAS.
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Affiliation(s)
- Anita Johansson
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Division of Psychiatry, Skaraborg Hospital, Skövde, Sweden.
| | - Mats Ewertzon
- Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden; Swedish National Family Care Competence Centre, Kalmar, Sweden.
| | - Birgitta Andershed
- Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, Sweden; Department of Nursing, Gjøvik University College, Gjøvik, Norway.
| | - Agneta Anderzen-Carlsson
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Centre for Health Care Sciences, Örebro, Sweden.
| | - Salmir Nasic
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
| | - Arne Ahlin
- National Board of Institutional Care, SiS Ungdomshem Margretelund, Lidkoping, Sweden.
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