| 1. |
- Apostolou, Eirini, et al.
(författare)
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Saliva antibody-fingerprint of reactivated latent viruses after mild/asymptomatic COVID-19 is unique in patients with myalgic-encephalomyelitis/chronic fatigue syndrome
- 2022
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Ingår i: Frontiers in Immunology. - : Frontiers Media SA. - 1664-3224. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundMyalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic disease considered to be triggered by viral infections in a majority of cases. Symptoms overlap largely with those of post-acute sequelae of COVID-19/long-COVID implying common pathogenetic mechanisms. SARS-CoV-2 infection is risk factor for sustained latent virus reactivation that may account for the symptoms of post-viral fatigue syndromes. The aim of this study was first to investigate whether patients with ME/CFS and healthy donors (HDs) differed in their antibody response to mild/asymptomatic SARS-CoV-2 infection. Secondly, to analyze whether COVID-19 imposes latent virus reactivation in the cohorts.MethodsAnti-SARS-CoV-2 antibodies were analyzed in plasma and saliva from non-vaccinated ME/CFS (n=95) and HDs (n=110) using soluble multiplex immunoassay. Reactivation of human herpesviruses 1-6 (HSV1, HSV2, VZV, EBV, CMV, HHV6), and human endogenous retrovirus K (HERV-K) was detected by anti-viral antibody fingerprints in saliva.ResultsAt 3-6 months after mild/asymptomatic SARS-CoV-2 infection, virus-specific antibodies in saliva were substantially induced signifying a strong reactivation of latent viruses (EBV, HHV6 and HERV-K) in both cohorts. In patients with ME/CFS, antibody responses were significantly stronger, in particular EBV-encoded nuclear antigen-1 (EBNA1) IgG were elevated in patients with ME/CFS, but not in HDs. EBV-VCA IgG was also elevated at baseline prior to SARS-infection in patients compared to HDs.ConclusionOur results denote an altered and chronically aroused anti-viral profile against latent viruses in ME/CFS. SARS-CoV-2 infection even in its mild/asymptomatic form is a potent trigger for reactivation of latent herpesviruses (EBV, HHV6) and endogenous retroviruses (HERV-K), as detected by antibody fingerprints locally in the oral mucosa (saliva samples). This has not been shown before because the antibody elevation is not detected systemically in the circulation/plasma.
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| 2. |
- Bernhoff, Gabriella, et al.
(författare)
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The pain drawing as an instrument for identifying cervical spine nerve involvement in chronic whiplash-associated disorders
- 2016
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Ingår i: Journal of Pain Research. - : DOVE MEDICAL PRESS LTD. - 1178-7090. ; 9, s. 397-404
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of the study was to investigate the psychometric properties of a standardized assessment of pain drawing with regard to clinical signs of cervical spine nerve root involvement. Design: This cross-sectional study included data collected in a randomized controlled study. Patients: Two hundred and sixteen patients with chronic (amp;gt;= 6 months) whiplash-associated disorders, grade 2 or 3, were included in this study. Methods: The validity, sensitivity, and specificity of a standardized pain drawing assessment for determining nerve root involvement were analyzed, compared to the clinical assessment. In addition, we analyzed the interrater reliability with 50 pain drawings. Results: Agreement was poor between the standardized pain drawing assessment and the clinical assessment (kappa = 0.11, 95% CI: -0.03 to 0.20). Sensitivity was high (93%), but specificity was low (19%). Interrater reliability was good (kappa = 0.64, 95% CI: 0.53 to 0.76). Conclusion: The standardized pain drawing assessment of nerve root involvement in chronic whiplash-associated disorders was not in agreement with the clinical assessment. Further research is warranted to optimize the utilization of a pain/discomfort drawing as a supportive instrument for identifying nerve involvement in cervical spinal injuries.
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| 3. |
- Hannestad, Ulf, et al.
(författare)
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Post-COVID sequelae effect in chronic fatigue syndrome: SARS-CoV-2 triggers latent adenovirus in the oral mucosa
- 2023
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Ingår i: Frontiers in Medicine. - : FRONTIERS MEDIA SA. - 2296-858X. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- The post-viral fatigue syndromes long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have multiple, potentially overlapping, pathological processes. These include persisting reservoirs of virus, e.g., SARS-CoV-2 in long COVID patients tissues, immune dysregulation with or without reactivation of underlying pathogens, such as Epstein-Barr virus (EBV) and human herpesvirus 6 (HHV6), as we recently described in ME/CFS, and possibly yet unidentified viruses. In the present study we tested saliva samples from two cohorts for IgG against human adenovirus (HAdV): patients with ME/CFS (n = 84) and healthy controls (n = 94), with either mild/asymptomatic SARS-CoV-2 infection or no infection. A significantly elevated anti-HAdV IgG response after SARS-CoV-2 infection was detected exclusively in the patient cohort. Longitudinal/time analysis, before and after COVID-19, in the very same individuals confirmed HAdV IgG elevation after. In plasma there was no HAdV IgG elevation. We conclude that COVID-19 triggered reactivation of dormant HAdV in the oral mucosa of chronic fatigue patients indicating an exhausted dysfunctional antiviral immune response in ME/CFS, allowing reactivation of adenovirus upon stress encounter such as COVID-19. These novel findings should be considered in clinical practice for identification of patients that may benefit from therapy that targets HAdV as well.
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| 4. |
- Patomella, Ann-Helen, et al.
(författare)
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General practitioners' reasoning on risk screening and primary prevention of stroke : a focus group study
- 2018
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Ingår i: BMC Family Practice. - : BioMed Central (BMC). - 1471-2296. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundBy screening and modifying risk factors, stroke incidence can be reduced. Clinical guidelines states that primary prevention of stroke is a responsibility and task of primary health care, but research shows that this not always the case. The aim of the study was to explore and describe what characterizes GPs' reasoning around risk screening and primary prevention among persons at risk for stroke in primary health care.MethodsA qualitative design based in a grounded theory approach was chosen in order to investigate this unexplored research area. Data collection was done using focus group interviews and data was analysed using a constant comparative method. Twenty-two GPs were interviewed in four focus groups.ResultsFindings showed that GPs perceived difficulties in prioritizing patients with an unhealthy lifestyle and described a lack of systematicity in their procedures, which complicated their clinical decisions concerning patients with stroke risk factors. The results showed a lack of systematic risk screening methods. Time constraints and the reimbursement system were described as hindering the preventive work.ConclusionThere is a need for a more proactive, transparent and systematic approach in the distribution of GPs' time and reimbursement of prevention in primary health care. The findings suggest, by developing new methods and approaches such as digital clinical decision-making tools and by implementing inter-professional team-work, the quality of the primary prevention of stroke could be improved.
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| 5. |
- Taloyan, Marina, et al.
(författare)
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Physical-mental multimorbidity in a large primary health care population in Stockholm County, Sweden
- 2023
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Ingår i: Asian Journal of Psychiatry. - : Elsevier. - 1876-2018 .- 1876-2026. ; 79
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Tidskriftsartikel (refereegranskat)abstract
- Background: Multimorbidity of mental and physical disorders may be common. Our objectives were to estimate the prevalence of mental disorders and determine physical-mental multimorbidity relationships adjusted for sex and age within a primary care population in Region Stockholm, Sweden.Methods: From 2.4 million Region Stockholm inhabitants, we included adult patients with >= 1 primary care consultation from 2013 through 2017. We clustered 40 physical diagnoses into 9 categories and grouped mental disorders into mild-moderate (i.e., depression, anxiety, stress disorder, sleep disturbance) or severe (i.e., bipolar disorder, schizophrenia).Results: Of 1 105 065 patients, mean age was 49 years, 56% were females, and nearly one-third had a mental disorder (97% mild-moderate). Adjusted odds ratios (AOR) for mild-moderate and severe mental disorders were highest in patients with alcohol abuse (AOR=3.7, 95% CI 3.6-3.8; AOR=7.2, 95% CI 6.7-7.6, respectively) vs. those with no abuse. Higher odds for either level of mental comorbidity occurred in patients with chronic heart failure (CHF), cerebrovascular disease, Transient ischemic attack (TIA), Chronic obstructive pulmonary disease (COPD), Gastroesophageal reflux disease-irritable bowel syndrome (GERD-IBS), chronic pain, dementia, nicotine dependence, and Parkinson's disease. For mild-moderate mental disorders, AOR in males was highest (1.45) at age 28 and was below 1.0 after age 46; AOR in females was highest (1.30) at age 38 and was below 1.0 after age 38. For severe mental disorders, AOR was below 1.0 after age 58 in males and after age 62 in females.Conclusion: Physical-mental multimorbidity was common in primary care patients in Sweden, with the highest odds occurring in those who were female, younger, and/or had an alcohol abuse disorder.
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| 6. |
- Tu, Ruibo, et al.
(författare)
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Neuropathic Pain Diagnosis Simulator for Causal Discovery Algorithm Evaluation
- 2019
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Ingår i: Advances in neural information processing systems 32 (NIPS 2019). - : Neural Information Processing Systems (NIPS).
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Konferensbidrag (refereegranskat)abstract
- Discovery of causal relations from observational data is essential for many disciplines of science and real-world applications. However, unlike other machine learning algorithms, whose development has been greatly fostered by a large amount of available benchmark datasets, causal discovery algorithms are notoriously difficult to be systematically evaluated because few datasets with known ground-truth causal relations are available. In this work, we handle the problem of evaluating causal discovery algorithms by building a flexible simulator in the medical setting. We develop a neuropathic pain diagnosis simulator, inspired by the fact that the biological processes of neuropathic pathophysiology are well studied with well-understood causal influences. Our simulator exploits the causal graph of the neuropathic pain pathology and its parameters in the generator are estimated from real-life patient cases. We show that the data generated from our simulator have similar statistics as real-world data. As a clear advantage, the simulator can produce infinite samples without jeopardizing the privacy of real-world patients. Our simulator provides a natural tool for evaluating various types of causal discovery algorithms, including those to deal with practical issues in causal discovery, such as unknown confounders, selection bias, and missing data. Using our simulator, we have evaluated extensively causal discovery algorithms under various settings.
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