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- Ekelund, Ulf, et al.
(författare)
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Effektiviserad utredning möjlig vid misstänkt akut koronart syndrom. Nya undersökningsmetoder kan ge bättre vårdkvalitet och spara resurser
- 2005
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Ingår i: Läkartidningen. - 0023-7205. ; 102:7, s. 464-466
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Tidskriftsartikel (refereegranskat)abstract
- The immediate evaluation of patients with suspected acute coronary syndrome (ACS) in the emergency department (ED) has remained almost unchanged for decades. At the same time, therapy for established ACS has undergone a remarkable and successful change towards early active intervention. Studies show that 7 out of 10 patients admitted with a suspicion of ACS do not have it, and that 2-5% of the patients with ACS are incorrectly sent home from the ED. With new diagnostic strategies, including e.g. risk prediction algorithms, new blood samples for plaque instability, special investigations like echocardiography, myocardial perfusion imaging and magnetic resonance imaging, as well as the Chest Pain Unit concept, improvements should definitely be possible. With the structured and evidence-based use of such strategies, it is our belief that more patients can be managed as outpatients, that length of stay can be shortened for those admitted, and that some patients with ACS can get an earlier adequate intervention.
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| 3. |
- Holmquist, Peter, et al.
(författare)
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Tubular function in diabetic children assessed by Tamm-Horsfall protein and glutathione S-transferase
- 2008
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Ingår i: Pediatric Nephrology. - : Springer Science and Business Media LLC. - 1432-198X .- 0931-041X. ; 23:7, s. 1079-1083
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Tidskriftsartikel (refereegranskat)abstract
- In a previous study, we found urinary excretion of Tamm-Horsfall protein (THP) to be persistently decreased in 25% of patients during the first year after diagnosis of diabetes mellitus. We thus wanted to study another marker for distal tubular function, pi glutathione S-transferase (pi-GST) and compare this and THP with proximal tubular function evaluated with alpha-GST and alpha-1-microglobulin (HC) in patients with longer duration of diabetes. One hundred and eighty-four diabetic and 16 control children were studied with timed overnight urine collections. Median age was 14 years, and median age at diagnosis was 8 years. The urinary excretion of alpha- and pi-GST was significant lower in diabetic than control children. There were no differences in the excretion of HC and THP. Diabetic children with decreased alpha-GST had higher albumin excretion, HbA(1c) levels, and longer diabetes duration but decreased THP excretion and cystatin-C clearance compared with those with normal excretion. In contrast, a decreased pi-GST or THP excretion was not associated with such differences. Diabetic children with increased HC excretion had increased HbA(1c) levels. Diabetic children, before the stage of microalbuminuria, may have signs of both proximal and distal tubular dysfunction, which is related to diabetes duration and poor metabolic control. Alpha-GST and pi-GST seem to be more sensitive than other parameters studied.
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| 4. |
- Holmquist, Peter, et al.
(författare)
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Urinary transforming growth factor-1, collagen IV and the effect of insulin in children at diagnosis of diabetes mellitus
- 2009
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Ingår i: Scandinavian Journal of Urology and Nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 43:2, s. 142-147
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Tidskriftsartikel (refereegranskat)abstract
- Objective. This study investigated whether metabolic derangement at diagnosis of diabetes mellitus affects the function of the basement membrane and the excretion of several components and whether insulin treatment can normalize this. It was designed to evaluate urinary excretion rates of transforming growth factor-1 (TGF-1), the carboxy-terminal domain of collagen IV (NC1) and albumin in children during the first 20 days of treatment after diagnosis of type 1 diabetes. Material and methods. Thirty-four newly diagnosed diabetic children between 4 and 16 years of age and 26 healthy children of matching age were studied with timed overnight urine collections. Urine was collected during the first 20 days of treatment. Results. Urinary excretion of albumin and TGF-1 in diabetic children were significantly increased at entry but normalized during 20 days of treatment with insulin compared with control children. In contrast, the non-significant high NC1 excretion at diagnosis did not change but became significantly increased after 20 days of insulin treatment. Overall, the kidney size was within normal limits and unaffected by treatment. The largest kidneys had less NC1 excretion (R= - 0.67, p0.05, n=13) and a lower glomerular filtration rate (R= - 0.77, p0.01, n=10) than the smallest kidneys. After 20 days of treatment TGF-1 excretion had decreased in children with kidney size 8.5 cm. Conclusion. Correction of the metabolic derangement with insulin decreased excretion of albumin and TGF-1, but had no effect on kidney size and urine NC1 excretion, presumably because the observation period was too short.
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- Kalani, Majid, et al.
(författare)
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Beneficial effects of dalteparin on haemostatic function and local tissue oxygenation in patients with diabetes, severe vascular disease and foot ulcers.
- 2007
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Ingår i: Thrombosis research. - : Elsevier BV. - 0049-3848 .- 1879-2472. ; 120:5, s. 653-61
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: A state of hypercoagulation and fibrinolytic dysfunction is present in individuals with diabetes, which may contribute to disturbed skin microcirculation and impaired ulcer healing. We have previously reported an improved outcome of chronic diabetic foot ulcers during treatment with dalteparin. In the present study we investigated the effects of dalteparin on skin microcirculation and haemostatic function. MATERIALS AND METHODS: 87 patients with diabetes, peripheral arterial obliterative disease and chronic foot ulcers were investigated in a prospective, randomised, double-blind and placebo-controlled study. They were randomised to treatment with subcutaneous injections of 5000 U dalteparin (n=44) or placebo (n=43), once daily until ulcer healing or for a maximum of six months. Plasma fibrinogen, fibrin gel structure [permeability coefficient (Ks) and fiber mass/length ratio (mu)], prothrombin fragment 1+2 (F1+2) antigen, plasminogen activator inhibitor-1 (PAI-1) activity and tissue plasminogen activator (tPA) antigen were analysed before randomization (baseline value), and at the end of the treatment period. The skin microcirculation of the foot was investigated by transcutaneous oxygen tension (TcPO(2)) and laser Doppler fluxmetry (LDF). RESULTS: The changes (Delta-values) of Ks, mu, tPA and TcPO(2) were higher (p<0.05) during treatment with dalteparin, as compared to the changes during treatment with placebo. At baseline, plasma fibrinogen and Ks were significantly correlated to TcPO(2). CONCLUSIONS: Local skin oxygenation improved and a less thrombogenic fibrin gel structure was formed in patients treated with dalteparin. Beneficial effects on haemostatic function are likely to contribute to the improved skin oxygenation observed during treatment with dalteparin.
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| 8. |
- Lövestam Adrian, Monica, et al.
(författare)
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Sight-threatening retinopathy is associated with lower mortality in type 2 diabetic subjects: A 10-year observation study.
- 2007
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Ingår i: Diabetes Research and Clinical Practice. - : Elsevier BV. - 1872-8227 .- 0168-8227. ; 77:1, s. 141-147
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To study associations between diabetic retinopathy and development of stroke, myocardial infarction and death in type 2 diabetic patients. Methods: During a 10-year observation period, 363 type 2 diabetic patients (diagnosis >= 30 years of age) attending an outpatient clinic were studied regarding the prevalence and incidence of retinopathy and associated risk factors, i.e., (HbA(1c), blood pressure, albuminuria, plasma creatinine, age, sex and diabetes duration) in relation to the development of myocardial infarction, stroke and death. The degree of retinopathy was classified as no retinopathy, background or sight-threatening retinopathy, i.e., clinically significant macular edema, severe non-proliferative or proliferative retinopathy. Results: During the study period, 62 patients had had myocardial infarction, 54 stroke and 99 patients died. Patients with sight-threatening retinopathy at baseline (n = 41) had a 2.2-fold increased (p < 0.01) risk for death compared to patients with no or background retinopathy, even when controlled for medical risk factors. When adjusted for medical risk factors, patients with no retinopathy at baseline (n = 226) who remained without retinopathy or developed background retinopathy (n = 187) during the study period, had a 3.6-fold increased risk for death (95% CI, 1.1, 11.8), (p = 0.03), compared to patients who developed sight-threatening retinopathy (n = 39), while the incidence of myocardial infarction did not differ. More patients who developed sight-threatening retinopathy were treated with ACE inhibitors than patients who did not (41% versus 24%; p = 0.03). Conclusion: Despite more medical risk factors, patients who developed sight-threatening retinopathy had lower mortality compared to patients with no or background retinopathy at follow-up. More patients who developed sight-threatening retinopathy were treated with ACE inhibitors but this seemed not to have influenced the lower mortality rate in this group, whereas the use of ACE inhibitors in patients who did not develop sight-threatening retinopathy was connected with lower mortality rate.
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| 9. |
- Ohlsson, Sophie, et al.
(författare)
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Monocyte chemoattractant protein 1 is a prognostic marker in ANCA-associated small vessel vasculitis.
- 2009
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Ingår i: Mediators of Inflammation. - New York, NY, USA : Hindawi Limited. - 0962-9351 .- 1466-1861. ; 2009:Jul 5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The (anti neutrophil cytoplasmatic autoantibody ANCA), associated small vessel vasculitides (ASVV) are relapsing-remitting inflammatory disorders, involving various organs, such as the kidneys. (Monocyte chemoattractant protein 1 MCP-1) has been shown to be locally up regulated in glomerulonephritis and recent studies have pointed out MCP-1 as a promising marker of renal inflammation. Here we measure urinary cytokine levels in different phases of disease, exploring the possible prognostic value of MCP-1, together with (interleukin 6 IL-6), (interleukin 8 IL-8) and (immunoglobulin M IgM). METHODS: MCP-1, IL-6 and IL-8 were measured using commercially available ELISA kits, whereas IgM in the urine was measured by an in-house ELISA. RESULTS: The MCP-1 levels in urine were significantly higher in patients in stable phase of the disease, compared with healthy controls. Patients in stable phase, with subsequent adverse events; had significantly higher MCP-1 values than patients who did not. MCP-1 and IgM both tended to be higher in patients relapsing within three months, an observation, however, not reaching statistical significance. Urinary levels of IL-6 correlated with relapse tendency, and IL-8 was associated with disease outcome. CONCLUSIONS: Patients with ASVV have raised cytokine levels in the urine compared to healthy controls, even during remission. Raised MCP-1 levels are associated with poor prognosis and possibly also with relapse tendency. The association with poor prognosis was stronger for U-MCP-1 than for conventional markers of disease like CRP, BVAS, and ANCA, as well as compared to candidate markers like U-IgM and U-IL-8. We thus consider U-MCP-1 to have promising potential as a prognostic marker in ASVV.
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