| 11. |
- André, Malin, 1949-, et al.
(author)
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The management of infections in children in general practice in Sweden. : a repeated 1-week diagnosis-prescribing study in 5 counties in 2000 and 2002.
- 2005
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In: The Journal of Infectious Diseases. - : Informa UK Limited. - 0022-1899 .- 0036-5548 .- 1651-1980. ; 37:11-12, s. 863-869
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Journal article (peer-reviewed)abstract
- A diagnosis-prescribing study was performed in 5 Swedish counties during 1 week in November in 2000 and repeated in 2002. The aim of the present study was to analyse data for children 0-15y of age who consulted a general practitioner with symptoms of an infection. During the 2 weeks studied, 4049 children were consulted. Respiratory tract infections (RTI) were the predominant diagnoses, above all among the youngest children, while the proportion of urinary tract infections and skin infections increased with increasing age. Between the y 2000 and 2002, the proportion of children allocated the diagnosis streptococcal tonsillitis and pneumonia decreased (p<0.01 and p<0.001, respectively) while the proportion of common cold increased (p<0.001). Antibiotic prescribing decreased from 55% to 48% (p<0.001) for respiratory infections between the years studied. The only significant changes in type of antibiotics prescribed were the increase of isoxazolylpenicillins (p<0.001) used for skin infection and the decrease of macrolides (p=0.001). A diagnostic test was used in more than half of the consultations. Of children allocated a RTI diagnosis, 36% were prescribed antibiotics when a C-reactive protein test was performed compared to 58% in those not tested. Further studies are needed in general practice to determine the optimal use of near-patient tests in children with RTI.
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| 12. |
- Björklund, L., et al.
(author)
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Aspirin in cardiology - benefits and risks
- 2009
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In: INTERNATIONAL JOURNAL OF CLINICAL PRACTICE. - : Hindawi Limited. - 1368-5031 .- 1742-1241. ; 63:3, s. 468-477
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Research review (peer-reviewed)
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| 13. |
- Bång, Angela, et al.
(author)
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Lower mortality after prehospital recognition and treatment followed by fast tracking to coronary care compared with admittance via emergency department in patients with ST-elevation myocardial infarction.
- 2008
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In: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 129:3, s. 325-332
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To describe the short-and long-term outcome among patients with an ST-elevation myocardial infarction (STEMI), assessed and treated by the emergency medical services (EMS) in relation to whether they were fast tracked to a coronary care unit (CCU) or admitted via the emergency department (ED). METHODS: Consecutive patients admitted to the CCU at Sahlgrenska University Hospital with ST elevations on admission ECG were analysed with respect to whether they by the EMS were fast tracked to the CCU or the adjacent coronary angiography laboratory (direct CCU group; n=261) or admitted via the ED (ED group; n=235). RESULTS: Whereas the two groups were similar with regard to age and previous history, those who were fast tracked to CCU were more frequently than the ED patients diagnosed and treated as STEMI already prior to hospital admission. Reperfusion therapy was more commonly applied in the CCU group compared with the ED group (90% vs 67%; <0.0001). The delay times (median) were shorter in the direct CCU group than in the ED group, with a difference of 10 min from the onset of symptoms to arrival in hospital and 25 min from hospital arrival to the start of reperfusion treatment (primary PCI or in-hospital fibrinolysis). Patients in the direct CCU group had lower 30-day mortality (7.3% vs. 15.3%; p=0.004), as well as late mortality (>30 days to five years) (11.6% vs. 20.6%; p=0.008). CONCLUSION: Among patients transported with ambulance due to STEMI there was a significant association between early recognition and treatment followed by fast tracking to the CCU and long term survival. A higher rate of and a more rapid revascularisation were probably of significant importance for the outcome.
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| 14. |
- Copland, Lotta, 1969, et al.
(author)
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Validity of the ActiReg system and a physical activity interview in assessing total energy expenditure in long-term survivors after total gastrectomy.
- 2008
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In: Clinical nutrition (Edinburgh, Scotland). - : Elsevier BV. - 1532-1983 .- 0261-5614. ; 27:6, s. 842-8
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Journal article (peer-reviewed)abstract
- BACKGROUND & AIMS: Malnutrition is common after total gastrectomy. There is a need for clinically useful methods to assess energy requirements. We aimed to validate measurements of energy expenditure by an activity monitor (ActiReg) and a physical activity interview (HPAQ(modified)), in long-term survivors after gastrectomy for gastric carcinoma, using doubly labelled water as reference method. METHODS: Total energy expenditure (TEE) was estimated by DLW (14 days), ActiReg (3 days) and HPAQ(modified) (7 days) in 15 patients. Measurements were repeated after 12 months. Basal metabolic rate was measured with indirect calorimetry. RESULTS: ActiReg and HPAQ(modified) both underestimated TEE by 180 (+/-254 SD) and 130 (+/-326 SD)kcalday(-1), i.e. 14% vs. 12%, respectively. However, this was evident only at higher levels of physical activity (PAL(DLW)> or =1.65), whereas at lower levels (PAL<1.65) no difference was found. There were no changes in TEE over time independent of the method used. DLW and ActiReg had approximately the same width of the 95% confidence interval of this estimate, while it was 2.4 times larger by HPAQ(modified). CONCLUSION: Both simple methods underestimated total energy expenditure at higher, but not at lower physical activity levels. The ActiReg method appears useful to estimate changes in TEE over time.
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| 15. |
- Ekström, Anne-Berit, 1960, et al.
(author)
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Cognition and adaptive skills in myotonic dystrophy type 1: a study of 55 individuals with congenital and childhood forms.
- 2009
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In: Dev Med Child Neurol. - : Wiley. - 1469-8749 .- 0012-1622. ; 51:12, s. 982-90
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Journal article (peer-reviewed)abstract
- Aims To investigate cognitive abilities and adaptive skills in children and adolescents with myotonic dystrophy type 1 (DM1) and correlate the findings to the cytosine-thymine-guanine (CTG) repeat expansion size. Method Cognitive level was assessed in 55 children and adolescents with DM1 (31 males, 24 females; mean age 12y 1mo, SD 5y 1mo; range 2y 7mo–21y 5mo) divided into the following categories: severe congenital DM1 (n=19), mild congenital DM1 (n=18), and childhood DM1 (n=18). The Griffiths Mental Developmental Scale, the Wechsler Scales, and the Vineland Adaptive Behavior Scales (VABS) for adaptive skills were used for this purpose. Results Learning disability was found in 95% of the severe congenital group, 83% of the mild congenital group, and 89% of the childhood DM1 group. The more severe the form of DM1, the lower the full-scale IQ (FSIQ; rs=0.28, p=0.044). The individuals with severe congenital and childhood DM1 had a significantly higher verbal IQ than performance IQ (severe congenital: mean difference 5.7, SD 5.7, p=0.008; childhood DM1: mean difference 9.8, SD 18.0, p=0.038). CTG repeat expansion correlated negatively with FSIQ (rs=−0.63, p<0.006). Almost all participants showed poor results on the VABS. There was a positive relationship between cognitive level and adaptive skills in the mild congenital (rs=0.95, p<0.01) and childhood DM1 groups (rs=0.92, p<0.01). Interpretation Children and adolescents with DM1 exhibit significant cognitive and adaptive problems.
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| 16. |
- Engström, Katarina, 1956, et al.
(author)
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Irradiation of myxoid/round cell liposarcoma induces volume reduction and lipoma-like morphology
- 2007
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In: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 46:6, s. 838-845
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Journal article (peer-reviewed)abstract
- The aim of the study was to investigate the clinical and morphological effects of radiotherapy in the treatment of myxoid/round cell liposarcoma (MLS/RCLS). Thirty-three primary and metastatic MLS/RCLS tumours in 15 patients were treated with radiation therapy. Twenty-seven of the 33 tumours were surgically removed after preoperative radiation (34-46 Gy) while six tumours were treated with radiotherapy alone (44-60 Gy). The pretreatment diagnosis was established in all 15 patients based on fine needle aspirates or histological findings. Tumour size was measured by CT or MRI before and after radiotherapy in 30 tumours. Thirteen tumours from 11 patients were genetically characterised before and/or after radiation therapy. Twenty-three of 30 irradiated tumours showed a median reduction in tumour volume of 52% and seven lesions a median progression of 36%. All 27 surgically removed tumours revealed histological features of radiation response. The most striking morphological changes were lipoma-like appearance, paucicellularity and hyalinisation. Twelve of 13 tumours analysed before and/or after radiation therapy showed the FUS-DDIT3 translocation. Radiation therapy of MLS/RCLS induces histopathologic accumulation of mature lipoma-like areas and tumour volume reduction that may facilitate resectability.
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| 17. |
- Forslund, Ola, et al.
(author)
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Cutaneous human papillomaviruses found in sun-exposed skin: Beta-papillomavirus species 2 predominates in squamous cell carcinoma
- 2007
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In: Journal of Infectious Diseases. - : Oxford University Press (OUP). - 1537-6613 .- 0022-1899. ; 196, s. 876-83
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Journal article (peer-reviewed)abstract
- Background. A spectrum of cutaneous human papillomaviruses (HPVs) is detectable in nonmelanoma skin cancers, as well as in healthy skin, but the significance that the presence of these types of HPV DNA has for the pathogenesis of skin cancer remains unclear. Methods. We studied 349 nonimmunosuppressed patients with skin lesions (82 with squamous cell carcinomas, 126 with basal cell carcinomas, 49 with actinic keratoses, and 92 with benign lesions). After superficial skin had been removed by tape, paired biopsy samples-from the lesion and from healthy skin from the same patient-were tested for HPV DNA. Risk factors for HPV DNA were analyzed in multivariate models. Results. Overall, 12% of healthy skin samples were positive for HPV DNA, compared with 26% of benign lesions, 22% of actinic keratoses, 18% of basal cell carcinomas, and 26% of squamous cell carcinomas. HPV DNA was associated with sites extensively exposed to the sun, both for the lesions (odds ratio [OR], 4.45 [95% confidence interval {CI}, 2.44-8.111) and for the healthy skin samples (OR, 3.65 [95% CI 1.79-7.44]). HPV types of Beta-papillomavirus species 2 predominate in squamous cell carcinomas (OR, 4.40 [95% CI, 1.92-10.06]), whereas HPV types of Beta-papillomavirus species 1 are primarily found in benign lesions (OR, 3.47 [95% CI, 1.72-6.99]). Conclusions. Cutaneous HPV types are primarily detected at sites extensively exposed to the sun. HPV types of Beta-papillomavirus species 2, but not of species 1, are associated with squamous cell carcinoma.
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| 18. |
- Herlitz, Johan, 1949, et al.
(author)
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Quality of life 15 years after coronary artery bypass grafting.
- 2009
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In: Coronary artery disease. - : Lippincott Williams & Wilkins. - 1473-5830 .- 0954-6928. ; 20:6, s. 363-9
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To describe changes in quality of life (QoL) during 15 years after coronary artery bypass grafting (CABG) and prediction of impaired QoL after 15 years. METHODS: All patients in western Sweden who underwent primary CABG without simultaneous valve surgery between 1988 and 1991 were included. QoL during a period of 15 years after CABG was evaluated with three instruments: the Nottingham Health Profile, the Psychological General Well-Being Index, and the Physical Activity Score. RESULTS: A total of 2000 patients took part in the survey, (none excluded) of whom 808 were still alive after 15 years and 79% answered the inquiry. Despite an ongoing decline in QoL over the years, an improvement in QoL was maintained in most sub-dimensions at the 15-year follow-up compared with that prior to surgery. Seven factors emerged as predictors of impaired QoL 15 years after CABG. They are as follows: (i) high age, (ii) female sex, (iii) history of diabetes, (iv) obesity, (v) prolonged stay in the intensive care unit, (vi) prolonged treatment on a ventilator, (vii) need for inotropic drugs at the time of surgery; of which the latter three might be secondary to left ventricular dysfunction. CONCLUSION: Despite an ongoing decline in QoL over the years, there was still an improvement in most aspects of QoL 15 years after CABG compared with that before surgery. Intensified early treatment of diabetes, obesity, and left ventricular dysfunction in CABG patients might allow an even better long-term QoL.
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| 19. |
- Johansson, J-E, et al.
(author)
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Gut protection by palifermin during autologous haematopoietic SCT.
- 2009
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In: Bone marrow transplantation. - : Springer Science and Business Media LLC. - 1476-5365 .- 0268-3369. ; 43:10, s. 807-11
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Journal article (peer-reviewed)abstract
- Conditioning therapy in connection with haematopoietic SCT (HSCT) induces a disruption of the intestinal barrier function facilitating the permeation of bacteria and endotoxin through the bowel wall with subsequent increased risk of septicaemia and a worsening of GVHD in the allogeneic setting. Palifermin (recombinant human keratinocyte growth factor) reduces the severity of oral mucositis with HSCT. The present trial investigates its effect on intestinal barrier function. Seventeen lymphoma patients undergoing autologous HSCT received palifermin. Intestinal permeability was assessed before the conditioning therapy and on days +4 and +14. Clinical oral and gastrointestinal toxicity was prospectively assessed in parallel. A comparison was made with matched historical study patients (n=21). Patients treated with palifermin had a significantly better preserved intestinal barrier function (P=0.01 on day +4) and were in less need of total parenteral nutrition (P=0.005) as compared with controls. No significant reduction of clinical gastrointestinal or oral toxicity was observed. The intestinal barrier function, normally disrupted by the conditioning therapy, is preserved by palifermin. Whether intestinal barrier preservation protects from invasive infections, and in the allogeneic setting diminishes GVHD severity, remains to be investigated in randomized controlled trials.
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| 20. |
- Kacprzyk, Lukasz, et al.
(author)
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Antimicrobial activity of histidine-rich peptides is dependent on acidic conditions
- 2007
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In: Biochimica et Biophysica Acta - Biomembranes. - : Elsevier BV. - 0005-2736 .- 1879-2642. ; 1768:11, s. 2667-2680
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Journal article (peer-reviewed)abstract
- Synthetic peptides composed of multiples of the consensus heparin-binding Cardin and Weintraub sequences AKKARA and ARKKAAKA are antimicrobial. Replacement of lysine and arginine by histidine in these peptides completely abrogates their antimicrobial and heparin-binding activities at neutral pH. However, the antibacterial activity against Gram-negative (Escherichia coli, Pseudomonas aeruginosa) and Gram-positive bacteria (Bacillus subtilis and Staphylococcus aureus) as well as the fungus Candida albicans, was restored at acidic conditions (pH 5.5). Fluorescence microscopy and FACS analysis showed that the binding of the histidine-rich peptides to E. coli and Candida was significantly enhanced at pH 5.5. Likewise, fluorescence studies for assessment of membrane permeation as well as electron microscopy analysis of peptide-treated bacteria, paired with studies of peptide effects on liposomes, demonstrated that the peptides induce membrane lysis only at acidic pH. No discernible hemolysis was noted for the histidine-rich peptides. Similar pH-dependent antimicrobial activities were demonstrated for peptides derived from histidine-rich and heparin-binding regions of human kininogen and histidine-rich glycoprotein. The results demonstrate that the presence of art acidic environment is an important regulator of the activity of histidine-rich antimicrobial peptides.
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