| 1. |
- Abelsson, Johanna, et al.
(författare)
-
Patients with polycythemia vera have worst impairment of quality of life among patients with newly diagnosed myeloproliferative neoplasms
- 2013
-
Ingår i: Leukemia and Lymphoma. - : Informa UK Limited. - 1042-8194 .- 1029-2403. ; 54:10, s. 2226-2230
-
Tidskriftsartikel (refereegranskat)abstract
- The quality of life (QoL) at the time of diagnosis of myeloproliferative neoplasm (MPN) has, to date, not been studied. One hundred and seventy-nine patients with MPN: 80 with essential thrombocythemia (ET), 73 with polycythemia vera (PV), 22 with primary myelofibrosis (PMF) and four with MPN undifferentiated, were included in this study. European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQC30) and the MPN-Symptom Assessment Form (MPN-SAF) were used to evaluate QoL. Fatigue was the most reported symptom in these patients. Patients with PV reported significantly higher mean scores for inactivity, dizziness, cough, itching, depression and lower total QoL compared to patients with ET. Patients with PV had significantly more headache and itching compared to patients with PMF. When the newly diagnosed patients with MPN were compared with a cohort of patients with MPN with mean disease duration of 7.8 years, the differences were most striking for patients with PMF, with significantly more fatigue, abdominal discomfort, concentration problems, insomnia, fever, weight loss and lower overall QoL developed over time.
|
|
| 2. |
- Berglund, Malin, 1970, et al.
(författare)
-
Hearing outcome after myringoplasty in Sweden: A nationwide registry-based cohort study
- 2020
-
Ingår i: Clinical Otolaryngology. - : Wiley. - 1749-4478 .- 1749-4486 .- 1365-2273. ; 45:3, s. 357-363
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives To present hearing results after successful primary myringoplasty surgeries registered in the Swedish Quality Registry for Myringoplasty and to evaluate the chance of hearing improvement and the risk of hearing loss. Design A retrospective nationwide cohort study based on prospectively collected registry data between 2002 and 2012. Settings Registry data from secondary and tertiary hospitals performing myringoplasty. Participants Patients with healed tympanic membrane after primary myringoplasty surgery performed from 2002 to 2012 in Sweden. Main outcome measures Postoperative hearing results, hearing gain and air-bone gap (ABG). Results In 2226 myringoplasties, air conduction audiograms were recorded, and the average preoperative pure tone average (PTA(4)) of the group was 28.5 dB, which improved postoperatively to 19.6 dB with an average of 8.8 dB improvement. Bone conduction was measured for 1476 procedures. Closure of the ABG to 10 dB or less was achieved in 51% of the ears and to less than 20 dB in 89% of the ears. Sixty-one percent of patients with preoperatively deteriorated hearing experienced improved hearing, but 3% of all patients experienced deteriorated hearing. After the surgery, 93% of the patients were satisfied. Conclusions Hearing results after successful myringoplasty surgery are often favourable, but although the tympanic membrane is healed, hearing improvement is not guaranteed, and hearing deterioration can also occur.
|
|
| 3. |
- Berglund, Malin, et al.
(författare)
-
Myringoplasty Outcomes From the Swedish National Quality Registry
- 2017
-
Ingår i: The Laryngoscope. - : John Wiley & Sons. - 0023-852X .- 1531-4995. ; 127:10, s. 2389-2395
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES/HYPOTHESIS: Data from patients registered for myringoplasty during 2002 to 2012 in the Swedish National Quality Registry for Myringoplasty.STUDY DESIGN: Both conventional myringoplasty and fat-graft techniques were used aimed at healing the tympanic membrane in noninfected ears.METHODS: Analysis was performed on data in a national database collected from 32 ear, nose, and throat clinics. Surgical procedures and outcomes, and patient satisfaction from a questionnaire were studied.RESULTS: The database was comprised of 3,775 surgical procedures, with follow-up available for analysis. One-third were children under the age of 15 years. The most common indication for surgery was infection prophylaxis. The overall healing rate of the tympanic membrane after surgery was 88.5%, with a high mean patient satisfaction. Complications registered were postoperative infection, tinnitus, or taste disturbance that occurred in 5.8% of patients.CONCLUSIONS: Swedish results for a large number of patients who completed myringoplasty are presented. The success rate in this study is comparable to other studies, and good patient-reported outcome measures of myringoplasty are presented. Databases for surgical procedures and clinical audits are systematic processes for continuous learning in healthcare. This study shows that clinical databases can be utilized to analyze national results of surgical procedures.LEVEL OF EVIDENCE: 2b Laryngoscope, 127:2389-2395, 2017.
|
|
| 4. |
- Berglund, Malin, 1970, et al.
(författare)
-
Tinnitus and taste disturbances reported after myringoplasty: Data from a national quality registry
- 2019
-
Ingår i: Laryngoscope. - : Wiley. - 0023-852X .- 1531-4995. ; 129:1, s. 209-215
-
Tidskriftsartikel (refereegranskat)abstract
- © 2018 The American Laryngological, Rhinological and Otological Society, Inc. Objectives/Hypothesis: Postoperative tinnitus and taste disturbances after myringoplasty are more common than previously reported. Study Design: This study was a retrospective analysis of prospectively collected data from the Swedish National Quality Registry for Myringoplasty. Methods: The analysis was performed on extracted data from all counties in Sweden collected from database A from 2002 to 2012 and database B from 2013 to 2016. Tinnitus and taste disturbance complications 1 year after myringoplasty were analyzed in relation to gender, age, procedure, and success rate. In database A, physicians reported tinnitus and taste disturbances. In database B, patients reported the complications. Results: A major difference was found when the complications were reported by physicians compared to when the complications were reported by patients. In database A, tinnitus was reported in 1.2% of the patients and taste disturbances in 0.5%. In database B, the frequencies were 12.3% and 11.2%, respectively. Tinnitus and taste disturbances were more frequent after conventional myringoplasty compared to those after fat grafting and were more frequent after primary compared to those after revision surgery when reported by physicians. Patients, however, reported the same frequency of tinnitus after fat graft myringoplasty compared to that after conventional myringoplasty (12.0% vs. 12.6%) and fewer taste disturbances after revision surgery. In follow-up assessments, complications persisted after surgery over a long time period. Conclusion: Tinnitus and taste disturbances are more common after myringoplasty when patients report their symptoms than when physicians report the symptoms. Level of Evidence: 2b. Laryngoscope, 2018.
|
|
| 5. |
|
|
| 6. |
- Björkholm, Magnus, et al.
(författare)
-
Success Story of Targeted Therapy in Chronic Myeloid Leukemia : A Population-Based Study of Patients Diagnosed in Sweden From 1973 to 2008
- 2011
-
Ingår i: Journal of Clinical Oncology. - 0732-183X .- 1527-7755. ; 29:18, s. 2514-2520
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose Chronic myeloid leukemia (CML) management changed dramatically with the development of imatinib mesylate (IM), the first tyrosine kinase inhibitor targeting the BCR-ABL1 oncoprotein. In Sweden, the drug was approved in November 2001. We report relative survival (RS) of patients with CML diagnosed during a 36-year period. Patients and Methods Using data from the population-based Swedish Cancer Registry and population life tables, we estimated RS for all patients diagnosed with CML from 1973 to 2008 (n = 3,173; 1,796 males and 1,377 females; median age, 62 years). Patients were categorized into five age groups and five calendar periods, the last being 2001 to 2008. Information on use of upfront IM was collected from the Swedish CML registry. Results Relative survival improved with each calendar period, with the greatest improvement between 1994-2000 and 2001-2008. Five-year cumulative relative survival ratios (95% CIs) were 0.21 (0.17 to 0.24) for patients diagnosed 1973-1979, 0.54 (0.50 to 0.58) for 1994-2000, and 0.80 (0.75 to 0.83) for 2001-2008. This improvement was confined to patients younger than 79 years of age. Five-year RSRs for patients diagnosed from 2001 to 2008 were 0.91 (95% CI, 0.85 to 0.94) and 0.25 (95% CI, 0.10 to 0.47) for patients younger than 50 and older than 79 years, respectively. Men had inferior outcome. Upfront overall use of IM increased from 40% (2002) to 84% (2006). Only 18% of patients older than 80 years of age received IM as first-line therapy. Conclusion This large population-based study shows a major improvement in outcome of patients with CML up to 79 years of age diagnosed from 2001 to 2008, mainly caused by an increasing use of IM. The elderly still have poorer outcome, partly because of a limited use of IM.
|
|
| 7. |
- Blimark, Cecilie, et al.
(författare)
-
Multiple myeloma and infections: a population-based study on 9253 multiple myeloma patients.
- 2015
-
Ingår i: Haematologica. - : Ferrata Storti Foundation (Haematologica). - 1592-8721 .- 0390-6078. ; 100:1, s. 107-13
-
Tidskriftsartikel (refereegranskat)abstract
- Infections are a major cause of morbidity and mortality in patients with multiple myeloma. To estimate the risk of bacterial and viral infections in multiple myeloma patients, we used population-based data from Sweden to identify all multiple myeloma patients (n=9253) diagnosed from 1988 to 2004 with follow up to 2007 and 34,931 matched controls. Cox proportional hazard models were used to estimate the risk of infections. Overall, multiple myeloma patients had a 7-fold (hazard ratio =7.1; 95% confidence interval = 6.8-7.4) risk of developing any infection compared to matched controls. The increased risk of developing a bacterial infection was 7-fold (7.1; 6.8-7.4), and for viral infections 10-fold (10.0; 8.9-11.4). Multiple myeloma patients diagnosed in the more recent calendar periods had significantly higher risk of infections compared to controls (P<0.001). At one year of follow up, infection was the underlying cause in 22% of deaths in multiple myeloma patients. Mortality due to infections remained constant during the study period. Our findings confirm that infections represent a major threat to multiple myeloma patients. The effect on infectious complications due to novel drugs introduced in the treatment of multiple myeloma needs to be established and trials on prophylactic measures are needed.
|
|
| 8. |
- Eriksson, Anders, et al.
(författare)
-
Diagnostic accuracy of postmortem imaging vs autopsy : a systematic review
- 2017
-
Ingår i: European Journal of Radiology. - : ELSEVIER IRELAND LTD. - 0720-048X .- 1872-7727. ; 89, s. 249-269
-
Forskningsöversikt (refereegranskat)abstract
- Background Postmortem imaging has been used for more than a century as a complement to medico-legal autopsies. The technique has also emerged as a possible alternative to compensate for the continuous decline in the number of clinical autopsies. To evaluate the diagnostic accuracy of postmortem imaging for various types of findings, we performed this systematic literature review. Data sources The literature search was performed in the databases PubMed, Embase and Cochrane Library through January 7, 2015. Relevant publications were assessed for risk of bias using the QUADAS tool and were classified as low, moderate or high risk of bias according to pre-defined criteria. Autopsy and/or histopathology were used as reference standard. Findings The search generated 2600 abstracts, of which 340 were assessed as possibly relevant and read in full-text. After further evaluation 71 studies were finally included, of which 49 were assessed as having high risk of bias and 22 as moderate risk of bias. Due to considerable heterogeneity - in populations, techniques, analyses and reporting - of included studies it was impossible to combine data to get a summary estimate of the diagnostic accuracy of the various findings. Individual studies indicate, however, that imaging techniques might be useful for determining organ weights, and that the techniques seem superior to autopsy for detecting gas Conclusions and Implications In general, based on the current scientific literature, it was not possible to determine the diagnostic accuracy of postmortem imaging and its usefulness in conjunction with, or as an alternative to autopsy. To correctly determine the usefulness of postmortem imaging, future studies need improved planning, improved methodological quality and larger materials, preferentially obtained from multi-center studies.
|
|
| 9. |
- Hultcrantz, Malin
(författare)
-
Clinical and epidemiological studies in myeloproliferative neoplasms
- 2013
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Myeloproliferative neoplasms (MPN), including polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), are clonal hematopoietic disorders characterized by excessive terminally differentiated myeloid cells. MPNs can progress to secondary myelofibrosis or acute myeloid leukemia (AML)/myelodysplastic syndromes (MDS). Although progress has been made in the understanding of the pathogenesis and management of MPNs, there are still unresolved issues regarding prognosis, causes of death, and risk factors for leukemic transformation. In patients with hematological malignancies, the risk of suicide and suicide attempts is largely unknown. We conducted a population-based study to establish patterns of survival in 9,384 MPN patients identified from the Swedish Cancer Registry between 1973 and 2008. Relative survival ratios were computed as measures of patient survival. Relative survival was significantly lower in all MPN subtypes compared to expected survival in the general population, reflected in 10-year relative survival ratios of 0.64 (95% confidence interval (CI); 0.62-0.67) in PV, 0.68 (0.64-0.71) in ET, and 0.21 (0.18-0.25) in PMF, respectively. Excess mortality was observed in patients of all MPN subtypes during all four calendar periods (p <0.001). Nevertheless, survival improved significantly over time (p <0.001); however, the improvement was less pronounced after the year 2000 and was confined to patients with PV and ET. In conclusion, our findings underline the assertion that all MPNs should be considered serious diseases that reduce life expectancy and highlight the need to improve treatment strategies for these patients. Through the Swedish Cancer Registry and our national MPN cohort we identified 9,563 MPN patients diagnosed between 1973 and 2005 and their 37,643 matched controls to assess excess mortality and causes of death. Cumulative incidence functions, calculated using a flexible parametric model, were used to estimate 10-year probabilities of death with 95% CIs for six categories of causes of death. The 10-year probability of dying from infections in male MPN patients aged 70-79 years at diagnosis were 4.5% (matched controls; 2.3%), from hematological malignancy 13.7% (0.2%), from cardiovascular disease 16.8% (15.0%), from cerebrovascular disease 5.5% (5.1%), from solid tumor 9.7% (11.5%), and from other disorders 24.9% (14.9%). The excess mortality in MPN patients declined due to a decrease in deaths from hematological malignancies during the first calendar period (1973-1982), infections, and in younger MPN patients, from cardiovascular disease. The overall improvement in 10-year mortality, observed in both patients and matched controls over time, was mainly explained by declines in cardiovascular death. In conclusion, the improved survival over time is multifactorial and can only partly be attributed to improved management of the underlying hematological malignancy. We conducted a nested case-control study to assess the role of MPN treatment and subsequent AML/MDS risk. From a nationwide MPN cohort (n=11,039; diagnosed 1958-2005), we identified 162 patients (cases) with transformation (153 and nine with subsequent AML and MDS diagnosis, respectively) and their 242 matched controls (MPN patients without AML/MDS transformation). Using logistic regression, odds ratios (ORs) were calculated as measures of AML/MDS risk. Forty-one (25%) of the 162 MPN patients with AML/MDS transformation were never exposed to alkylating agents, radioactive phosphorous (P32), or hydroxyurea (HU). The ORs for cases receiving 1 to 499 g, 500 to 999 g, more than 1,000 g of HU were 1.5 (95% CI; 0.6-2.4), 1.4 (0.6-3.4), and 1.3 (0.5-3.3), respectively, for AML/MDS development (not significant). Patients with MPNs who received P32 doses greater than 1,000 MBq and more than 1 g of alkylating agents had a 4.6-fold (2.1-9.8; p<0.002) and 3.4-fold (1.1-10.6; p<0.015) increased risk of AML/MDS, respectively. Thus, the risk of AML/MDS development after MPN diagnosis was not associated with HU treatment at any dosage. The fact that only 32% of patients with AML/MDS transformation received doses found here to be leukemogenic indicates a major role for non-treatmentrelated factors. To define incidence and risk factors for suicide and suicide attempts in patients with hematological malignancies, we conducted a population-based study in 47,220 patients with hematological malignancies and their 235,868 matched controls. Using Cox regression, the hazard ratios (HRs) for suicide and suicide attempts (combined end-point) in patients with hematological malignancies was 1.9 (95% CI; 1.5-2.3) compared to matched controls during the first three years after diagnosis. When more than three years had elapsed, there was no excess risk of suicide/suicide attempts (HR 1.1; 0.9-1.4). Patients with multiple myeloma carried the highest risk, HR 3.4 (2.3-5.0), and a pre-existing psychiatric disorder was strongly associated with an increased risk of suicide and suicide attempts (HR 23.3; 16.6-32.6). Although suicides contributed marginally to mortality in patients with hematological malignancies, awareness of risk factors for suicide/suicide attempts can facilitate identification of high-risk patients and enable preventive interventions
|
|
| 10. |
- Hultcrantz, Monica, et al.
(författare)
-
Interferons induce an antiviral state in human pancreatic islet cells
- 2007
-
Ingår i: Virology. - : Elsevier BV. - 0042-6822 .- 1096-0341. ; 367:1, s. 92-101
-
Tidskriftsartikel (refereegranskat)abstract
- Enterovirus infections, in particular those with Coxsackieviruses, have been linked to the development of type 1 diabetes (T1D). Although animal models have demonstrated that interferons (IFNs) regulate virus-induced T1D by acting directly on the beta cell, little is known on the human pancreatic islet response to IFNs. Here we show that human islet cells respond to IFNs by expressing signature genes of antiviral defense. We also demonstrate that they express three intracellular sensors for viral RNA, the toll like receptor 3 (TLR3) gene, the retinoic acid-inducible gene I (RIG-I) and the melanoma differentiation-associated gene-5 (MDA-5), which induce type I IFN production in infected cells. Finally, we show for the first time that the IFN-induced antiviral state provides human islets with a powerful protection from the replication of Coxsackievirus. This may be critical for beta cell survival and protection from virus-induced T1D in humans.
|
|
