Objective
Repeated hemarthrosis in hemophilia causes arthropathy with pain and dysfunction. The Hemophilia Joint Health Score (HJHS) was developed to be more sensitive for detecting arthropathy than ...the World Federation of Hemophilia (WFH) physical examination scale, especially for children and those using factor prophylaxis. The HJHS has been shown to be highly reliable. We compared its validity and sensitivity to the WFH scale.
Methods
We studied 226 boys with mild, moderate, and severe hemophilia at 5 centers. The HJHS was scored by trained physiotherapists. Study physicians at each site blindly determined individual and total joint scores using a series of visual analog scales.
Results
The mean age was 10.8 years. Sixty‐eight percent were severe (93% of whom were treated with prophylaxis), 15% were moderate (24% treated with prophylaxis), and 17% were mild (3% treated with prophylaxis). The HJHS correlated moderately with the physician total joint score (rs = 0.42, P < 0.0001) and with overall arthropathy impact (rs = 0.42, P < 0.0001). The HJHS was 97% more efficient than the WFH at differentiating severe from mild and moderate hemophilia. The HJHS was 74% more efficient than the WFH at differentiating subjects treated with prophylaxis from those treated on demand. We identified items on the HJHS that may be redundant or rarely endorsed and could be removed from future versions.
Conclusion
Both the HJHS and WFH showed evidence of strong construct validity. The HJHS is somewhat more sensitive for mild arthropathy; its use should be considered for studies of children receiving prophylaxis.
•A preoperative femoral nerve block does not seem to reduce pre- and postoperative delirium in the overall study-group.•A large proportion of patients with hip fracture suffer pre- and postoperative ...delirium and other complications.•Among the subgroup of patients with dementia, those that received a preoperative femoral nerve block seems to suffer fewer number of complications.•With a large proportion of patients with dementia, it is important to include them.
Patients with hip fracture often suffer complications leading to increased mortality and morbidity. Pain management are important, but opioids has many side effects. The aim of this study was to investigate whether Femoral Nerve Block (FNB) can reduce complications during hospital stay, with special focus on delirium compared to conventional pain management with opioids among patients with hip fracture, including those with dementia.
In a randomized controlled trial involving patients >70 years with hip fracture (trochanteric and cervical), including those with dementia. Preoperatively, patients (n=236) were consecutively assigned to receive FNB and opioids if required (intervention group, n = 116) or conventional pain management using opioids if required (control group, n = 120). Delirium was set according to different assessments and DSM-IV-TR criteria. Other complications were set by a specialist in geriatric medicine and a trained research nurse according to a predefined protocol.
Most patients, 157 (66%), were women, mean age was 84 (±6.7) years and 109 (46%) patients had dementia disorders. Forty-four patients (38.9%) developed delirium preoperatively in the intervention group compared to 59 (49.2%) patients in the control group (p=0.116). Common postoperative complications were pre- and postoperative delirium, nutritional problems, anaemia, constipation and urinary tract infection with no significant difference between the groups. In the subgroup analysis among patients with dementia, a large proportion developed delirium postoperative (96.3%) and they had a long duration of delirium during hospital stay (5.9 ±1.8), however no difference between the groups.
Despite less preoperative pain and need of opioids, FNB did not reduce the incidence of complications. However, a preoperative FNB may result in less preoperative delirium, but this should be further investigated. As pain treatment, FNB is a good alternative with few documented adverse effects in order to reduce pain and opioids among patients with hip fracture.
Patients with viral infections of the central nervous system (CNS) may present with a variety of neurological symptoms, most commonly dominated by either encephalitis or meningitis. The aetiological ...panorama varies in different parts of the world as well as over time. Thus, virological first-line diagnostics must be adapted to the current epidemiological situation and to the individual patient history, including recent travels. This review focuses on the diagnostics and treatment of viral CNS infections in the immunocompetent host from a Northern European perspective. Effective vaccines are available for viruses such as poliovirus and tick-borne encephalitis virus (TBEV) and for the childhood diseases morbilli (measles), rubella (German measles), parotitis (mumps) and varicella (chickenpox). However, cases do appear due to suboptimal immunization rates. In viral CNS infections, epidemiological surveillance is essential for establishing preventive strategies and for detecting emerging viruses. Knowledge of the possibilities and limitations of diagnostic methods for specific viral CNS infections is vital. A positive cerebral spinal fluid (CSF) polymerase chain reaction (PCR) finding is usually reliable for aetiological diagnosis. The demonstration of intrathecal antibody synthesis is useful for confirming the aetiology in a later stage of disease, hitherto sufficiently evaluated in herpes simplex encephalitis (HSE) and tick-borne encephalitis (TBE). Despite improved virological and differential diagnostic methods, aetiology remains unknown in about half of the cases with suspected viral encephalitis. Antiviral treatment is available chiefly for infections caused by herpesviruses, and acyclovir (aciclovir) is the drug of choice for empirical therapy in suspected viral encephalitis. However, randomized, controlled antiviral trials have only been conducted for HSE, while such studies are lacking in other viral CNS infections. Viral cytolysis and immune-mediated mechanisms may contribute to varying extents to neurological damage. Although the brain damage is believed to depend, to a varying degree, on the intrathecal host immune response, the use of corticosteroids in viral CNS infections is scarcely studied, as is specific treatment for neuroinflammation. Improved antiviral and immunomodulating treatment is desirable. Since neurological sequelae are still abundant, follow-up after severe viral CNS disease must include a neuropsychological assessment and an individually adapted rehabilitation plan.
The association between chronic obstructive pulmonary disease (COPD) and periodontal disease is sparsely studied. The aim was to describe the co-variation of periodontitis and lung function ...impairment in smokers. The hypothesis was that the destructive processes in the mouth and the lungs are interdependent due to a general individual susceptibility to detrimental effects of tobacco smoke. Smokers with COPD (n = 28) stage II and III according to GOLD guidelines and smokers without COPD (n = 29) and healthy non-smokers (n = 23) participated in the study. The groups of smokers were matched for cumulative exposure to tobacco smoke. Radiographic, general and dental clinical examination, lung function measurements and quality of life (SF-36) assessment were conducted. The relationship between respiratory and dental outcomes was analyzed. Dental health, assessed by plaque, gingival bleeding, periodontal pocket depth and loss of teeth was impaired in the smokers compared with non-smokers with no major differences between smokers with and without COPD. There was, however, a weak correlation between periodontitis and emphysema/impaired diffusion capacity. Impaired quality of life was associated with smoking and impaired lung function but not influenced by dental status. In conclusion periodontitis was strongly associated with smoking, weakly associated with lung tissue destruction and very weakly or even not at all associated with chronic airflow limitation. The results indicate that, although there was a co-variation between periodontitis and pathologic lung processes in smokers, the risk of developing COPD, as defined by spirometric outcomes, is not associated with the risk of impaired dental health in smokers.
To investigate the association between uranium in drinking water from drilled wells and aspects of kidney function measured by sensitive urine tests.
Three hundred and one of 398 eligible subjects ...(75.6%) aged 18–74 years with daily drinking water supplies from private drilled wells located in uranium-rich bedrock (exposed group) volunteered to participate along with 153 of 271 local controls (56.4%) who used municipal water. Participants responded to a questionnaire on their water consumption and general health, and provided a morning urine sample and drinking water for analysis.
The uranium content of well water samples (n=153) varied considerably (range <0.20–470μg/l, median 6.7μg/l, 5% >100μg/l), while uranium levels in all samples of municipal water (n=14) were below the limit of quantification (0.2μg/l). Urinary levels of uranium were more than eight times higher in exposed subjects than in controls (geometric means 38 and 4.3ng/l, respectively; p<0.001), but their mean urine lead levels were not significantly different. There was a strong curvilinear correlation between uranium in drinking water and in urine (r2=0.66). Levels of albumin, β2-microglobulin, protein HC as well as kappa and lambda immunoglobulin chains in urine from exposed and controls were similar. The N-acetyl-β-d-glucosaminidase (NAG) activity was significantly lower in the exposed group vs. controls, possibly secondary to differential storage duration of samples from the two groups. Even in regression models adjusting for gender, age and smoking no association of uranium in water and the kidney function parameters was observed. Using uranium in urine in the entire study group as a marker of exposure, however, a tendency of exposure-related increases of β2-microglobulin, protein HC and kappa chains were noted. This tendency was enhanced after exclusion of subjects with diabetes mellitus from the analysis.
Uranium levels in urine were strongly correlated to levels in drinking water from drilled wells. There were no clear signs of nephrotoxicity from uranium in drinking water at levels recorded in this study, but some indications of an effect were observed using uranium in urine as a measure of overall uranium exposure. The clinical relevance of these findings remains unclear.
The purpose of this study was to assess the ovarian function, fertility and bone mineral density in women who previously had treatment for different haematological malignancies (HMs). The overall ...survival and cure rates of patients with HMs have improved dramatically. The treatment affects fertility and bone density. Fifty‐two premenopausal women, from Stockholm region, were included in the study between 1998 and 2002, followed until 2011. The diagnoses were acute lymphoblastic leukaemia (n = 6), acute myeloid leukaemia (n = 10), chronic lymphocytic leukaemia (n = 1), chronic myeloid leukaemia (n = 12), Hodgkin lymphoma (n = 12) and non‐Hodgkin lymphoma (n = 11). Before treatment, women without children (43/52), when possible, were offered fertility preservation options. The mean age at diagnosis was 27, at final evaluation 39 yr. Thirty‐seven patients received HSCT; 26 allogeneic, 11 autologous. Before allogeneic HSCT, nineteen patients had myeloablative conditioning; seven had reduced‐intensity conditioning. Eleven patients got total body irradiation. Eight patients were transplanted with grafts from an HLA‐identical sibling donor, while 18 had unrelated donors. All women were in a menopausal state post‐therapy. Hormone replacement therapy (HRT) was given, and bone mineral density (BMD) was measured every other year. The serum levels of parathyroid hormone (PTH), free and bound calcium was within normal range. BMD measurements showed a slight increase over time in the spine with a mean of 0.015 g/cm2/yr. Four spontaneous pregnancies resulted in two babies and two discontinued pregnancies; two pregnancies were achieved with oocyte donation and surrogacy and one woman adopted a child. HRT sustains BMD in long‐term survivors from HMs. This study highlights the importance of HRT and fertility issues in this patient group.
Starting from our previously described PI3Kγ inhibitors, we describe the exploration of structure–activity relationships that led to the discovery of highly potent dual PI3Kγδ inhibitors. We explored ...changes in two positions of the molecules, including macrocyclization, but ultimately identified a simpler series with the desired potency profile that had suitable physicochemical properties for inhalation. We were able to demonstrate efficacy in a rat ovalbumin challenge model of allergic asthma and in cells derived from asthmatic patients. The optimized compound, AZD8154, has a long duration of action in the lung and low systemic exposure coupled with high selectivity against off-targets.
The aim of this study was to explore the content of rehabilitation plans after multimodal rehabilitation (MMR) for chronic pain patients, focusing on occupation-oriented measures. A secondary aim was ...to study how the individual rehabilitation plans had been carried out and implemented during 1 year after MMR. A multiple methods approach with quantitative and qualitative data was used. The quantitative part was descriptive and examined whether the rehabilitation plans were carried out, the number of recommendations in each plan and the type of measures suggested. The qualitative part constituted a content analysis of interviews. Vocational rehabilitation was the second most common recommendation for the whole group. The analysis of the interviews resulted in seven categories divided into two main categories: impeding factors and facilitating factors for rehabilitation. The compliance of professionals and external parties with the patients' rehabilitation plans, and the patients' positive experience of their change in behaviour, contributed to the completion of the rehabilitation plans. In conclusion, lack of follow-up from the professionals and negative bodily signals inhibited the completion of rehabilitation. Flexibility on the part of professionals and external actors regarding patients' rehabilitation plans as well as their own positive experiences of striving for change facilitated rehabilitation.
Abstract
Purpose: To evaluate body awareness and perceived health in patients with chronic pain after participation in a multimodal rehabilitation (MMR) programme and at 1-year follow-up. Method: ...Thirty-nine patients participated in a 5-week outpatient MMR programme. They were evaluated with the main outcome measures: the Body Awareness Scale (BAS) using an interview (BAS-I) and a movement test (BAS-Obs), the Nottingham Health Profile (NHP) and the Sense of Coherence (SOC). A subgroup analysis was conducted based on the BAS-Obs scores at the start of the MMR programme with cut-off at the upper quartile ≥ 26 point, classified as low body awareness; the three lower quartiles were classified as moderate/high body awareness. Results: All patients improved on the BAS-Obs and the BAS-I from the start to the end of the MMRP (p < 0.001) and at 1-year follow-up on four of the BAS-Obs subscales (p < 0.005). The moderate/high body awareness group improved on BAS-I, NHP and SOC (p < 0.01) and on two BAS-I subscales (p < 0.005), while the low body awareness group improved on one subscale (p = 0.003). Conclusion: Our results suggest that the use of the BAS-Obs assessment to identify patients with high or low levels of body awareness could play an important part in understanding the individual's clinical needs and be useful for developing an effective rehabilitation programme for patients with chronic pain.
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