| 1. |
- Björkenstam, Emma, et al.
(författare)
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Differences in psychiatric care utilization between refugees, non-refugee migrants and Swedish-born youth
- 2022
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Ingår i: Psychological Medicine. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; 52:7, s. 1365-1375
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe study aimed to examine differences in, and characteristics of psychiatric care utilization in young refugees who came to Sweden as unaccompanied or accompanied minors, compared with that of their non-refugee immigrant and Swedish-born peers.MethodsThis register-linkage cohort study included 746 688 individuals between 19 and 25 years of age in 2009, whereof 32 481 were refugees (2896 unaccompanied and 29 585 accompanied) and 32 151 non-refugee immigrants. Crude and multivariate Cox regression models yielding hazard ratios (HR) and 95% confidence intervals (CI) were conducted to investigate subsequent psychiatric care utilization for specific disorders, duration of residence and age at migration.ResultsThe adjusted HRs for psychiatric care utilization due to any mental disorder was significantly lower in both non-refugee and refugee immigrants when compared to Swedish-born [aHR: 0.78 (95% CI 0.76–0.81) and 0.75 (95% CI 0.72–0.77, respectively)]. Within the refugee group, unaccompanied had slightly lower adjusted risk estimates than accompanied. This pattern was similar for all specific mental disorders except for higher rates in schizophrenia, reaction to severe stress/adjustment disorders and post-traumatic stress disorder. Psychiatric health care utilization was also higher in immigrants with more than 10 years of residency in Sweden entering the country being younger than 6 years of age.ConclusionsFor most mental disorders, psychiatric health care utilization in young refugees and non-refugee immigrants was lower than in their Swedish-born peers; exceptions are schizophrenia and stress-related disorders. Arrival in Sweden before the age of 6 years was associated with higher rates of overall psychiatric care utilization.
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| 2. |
- Björkenstam, Marie, et al.
(författare)
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Case report of eosinophilic granulomatosis with polyangitis presenting as acute myocarditis.
- 2022
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Ingår i: Clinical case reports. - : Wiley. - 2050-0904. ; 10:10
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Tidskriftsartikel (refereegranskat)abstract
- This case presents a challenging diagnosis of EGPA presenting as eosinophilic myocarditis. It is a condition that can mimic many other diseases and where prompt diagnosis and early treatment is essential for recovery. The diagnosis was made after an endomyocardial biopsy (EMB) and showed the importance of EMB in the diagnostic work-up.
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| 3. |
- Bobbio, Emanuele, et al.
(författare)
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Diagnosis, management, and outcome of cardiac sarcoidosis and giant cell myocarditis: a Swedish single center experience.
- 2022
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Ingår i: BMC cardiovascular disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 22
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Tidskriftsartikel (refereegranskat)abstract
- Cardiac sarcoidosis (CS) and giant cell myocarditis (GCM) are rare diseases that share some similarities, but also display different clinical and histopathological features. We aimed to compare the demographics, clinical presentation, and outcome of patients diagnosed with CS or GCM.We compared the clinical data and outcome of all adult patients with CS (n=71) or GCM (n=21) diagnosed at our center between 1991 and 2020.The median (interquartile range) follow-up time for patients with CS and GCM was 33.5 [6.5-60.9] and 2.98 [0.6-40.9] months, respectively. In the entire cohort, heart failure (HF) was the most common presenting manifestation (31%), followed by ventricular arrhythmias (25%). At presentation, a left ventricular ejection fraction of<50% was found in 54% of the CS compared to 86% of the GCM patients (P=0.014), while corresponding proportions for right ventricular dysfunction were 24% and 52% (P=0.026), respectively. Advanced HF (NYHA≥IIIB) was less common in CS (31%) than in GCM (76%). CS patients displayed significantly lower circulating levels of natriuretic peptides (P<0.001) and troponins (P=0.014). Eighteen percent of patients with CS included in the survival analysis reached the composite endpoint of death or heart transplantation (HTx) compared to 68% of patients with GCM (P<0.001).GCM has a more fulminant clinical course than CS with severe biventricular failure, higher levels of circulating biomarkers and an increased need for HTx. The histopathologic diagnosis remained key determinant even after adjustment for markers of cardiac dysfunction.
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| 4. |
- Bobbio, Emanuele, et al.
(författare)
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Incidental cardiac findings on somatostatin receptor PET/CT: What do they indicate and are they of clinical relevance?
- 2022
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Ingår i: Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology. - : Springer Science and Business Media LLC. - 1532-6551. ; 29:3, s. 1159-1165
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Tidskriftsartikel (refereegranskat)abstract
- We present the case of a 47-year-old man with a history of recurrent episodes of frontal headache, fever, and chest discomfort as well as longstanding, difficult to treat arterial hypertension. Clinical work-up revealed the unexpected finding of an underlying pheochromocytoma as well as recent "silent" myocardial infarction. Our case highlights the importance of paying attention to incidental cardiac findings on somatostatin receptor positron emission tomography/computed tomography, as routinely performed in patients with clinically suspected neuroendocrine tumors. These incidental cardiac findings cannot only indicate a primary or secondary (metastatic) neuroendocrine tumor, but also areas of myocardial inflammation, as somatostatin receptors cannot only be found on the majority of neuroendocrine tumors, but also among other tissues on the surface of activated macrophages and lymphocytes. The detection of myocardial inflammation is of clinical importance and its underlying etiology should be evaluated to prompt eventual necessary treatment, as it is a potential driving force for cardiac remodeling and poor prognosis.
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| 5. |
- Bobbio, Emanuele, et al.
(författare)
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Short- and long-term outcomes after heart transplantation in cardiac sarcoidosis and giant-cell myocarditis: a systematic review and meta-analysis.
- 2022
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Ingår i: Clinical research in cardiology : official journal of the German Cardiac Society. - : Springer Science and Business Media LLC. - 1861-0692. ; 111:2, s. 125-140
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Tidskriftsartikel (refereegranskat)abstract
- Heart transplantation (HTx) is a valid therapeutic option for end-stage heart failure secondary to cardiac sarcoidosis (CS) or giant-cell myocarditis (GCM). However, post-HTx outcomes in patients with inflammatory cardiomyopathy (ICM) have been poorly investigated. We searched PubMed, Scopus, Science Citation Index, EMBASE, and Google Scholar, screened the gray literature, and contacted experts in the field. We included studies comparing post-HTx survival, acute cellular rejection, and disease recurrence in patients with and without ICM. Data were synthesized by a random-effects meta-analysis. We screened 11,933 articles, of which 14 were considered eligible. In a pooled analysis, post-HTx survival was higher in CS than non-CS patients after 1year (risk ratio [RR] 0.88, 95% confidence interval [CI] 0.60-1.17; I2=0%) and 5years (RR 0.72, 95% CI 0.52-0.91; I2=0%), but statistically significant only after 5years. During the first-year post-HTx, the risk of acute cellular rejection was similar for patients with and without CS, but after 5years, it was lower in those with CS (RR 0.38, 95% CI 0.03-0.72; I2=0%). No difference in post-HTx survival was observed between patients with and without GCM after 1year (RR 1.16, 95% CI 0.05-2.28; I2=0%) or 5years (RR 0.98, 95% CI 0.42-1.54; I2=0%). During post-HTx follow-up, recurrence of CS and GCM occurred in 5% and 8% of patients, respectively. Post-HTx outcomes in patients with CS and GCM are comparable with cardiac recipients with other heart failure etiologies. Patients with ICM should not be disqualified from HTx.
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