Characteristics of elderly people readmitted to the hospital during the first year after stroke. The Göteborg 70+ stroke study

BACKGROUND AND PURPOSE: Readmissions after acute stroke vary over time and with age and comorbidity. Knowledge of the reasons for readmissions and characteristics of readmitted patients is sparse. This 1-year prospective study examined whether readmissions were related to severity of the index stroke or to comorbidity and explored outcomes in readmitted patients with respect to daily life activities and health-related quality of life. METHODS: The study included 216 elderly patients (aged >/=70 years) discharged to their homes or a nursing home after index stroke. The main outcomes were readmission rates and reported diagnoses, performance of daily life activities and health-related quality of life. RESULTS: Nearly half (45%) of the patients were readmitted to the hospital after being discharged to their homes. One readmission was most common, and stroke-related diagnoses were most frequently reported as the reason for readmission. Different forms of heart disease were the next most common reason. The readmitted patients were significantly more dependent in daily life activities, and health-related quality of life was significantly lower among this group. CONCLUSIONS: Recurrent stroke and sequelae after stroke were major factors behind readmissions, followed by heart disease in elderly stroke patients. The readmitted patients were more dependent in daily life activities and reported a lower health-related quality of life compared with not readmitted patients.     

Impact of hemodialysis membrane and permeability on neutrophil transmigration in vitro

BACKGROUND/AIM: The impact of dialysis membrane permeability on neutrophil transmigration properties in vitro was examined in the present study. This issue has not been fully scrutinized before. METHODS: We studied the capacity of neutrophils collected from a group of dialysis patients randomly treated with cuprophan, low- or high-flux polysulfone, to transmigrate in vitro through a membrane covered with fibronectin (a main constituent of the endothelial basement membrane). The hemodialysis-induced quantitative changes in expression of adhesion molecules were examined in parallel. RESULTS: At the end of dialysis, neutrophils collected from patients treated with high-flux polysulfone dialyzers had a significantly higher transmigration index than neutrophils from patients treated with low-flux polysulfone membrane (p < 0.01) or cuprophan membrane (p < 0.01), and approached the level of transmigration observed in neutrophils collected from healthy controls. In the groups treated with low-flux polysulfone and cuprophan dialyzers, the transmigration capacity was significantly lower (p < 0.02) compared to neutrophils from healthy subjects. We also noted that differences between low- and high-flux polysulfone dialysis, in the context of transmigration properties, were not mirrored by changes in adhesion phenotype, which strengthens the view that there is no strict relationship between these two features. CONCLUSION: The study demonstrates that high-flux polysulfone dialysis, as opposed to low-flux polysulfone and cuprophan treatment, improves the transmigration properties of circulating neutrophils, despite similar effects on adhesion molecule phenotypes. A plausible mechanism is that potentially toxic middle range molecules that inhibit neutrophil migration are more efficiently eliminated during high-flux polysulfone dialysis, but this explanation requires further support.     

Somatic hypermutation and V(H) gene usage in mantle cell lymphoma

Abstract: Mantle cell lymphoma (MCL) is considered to derive from naïve, pregerminal center (GC) CD5⁺ B‐cells. However, the cell of origin has been questioned in recent studies that showed somatic hypermutations in the immunoglobulin (Ig) variable heavy chain (V_H) genes in subsets of MCL. To clarify this issue, we analyzed the IgV_H genes for the presence of somatic hypermutations in 51 MCL cases. Twenty percent of the MCL cases displayed somatically mutated V_H genes (defined as >2% mutated), whereas 80% showed unmutated V_H genes. This finding suggests that MCL is a genetically heterogeneous disease, with the majority of cases originating from unmutated pre‐GC B‐cells and a subset deriving from more mature B‐cells which have been exposed to the GC environment and have undergone somatic hypermutation. A biased V_H gene usage has been demonstrated in several B‐cell malignancies; however, this has not yet been investigated in MCL, although V_H4‐34 overusage has been indicated by small studies. Interestingly, we found a restricted usage of three individual V_H genes in our MCL material; V_H4‐34 (22%), V_H3‐21 (16%) and V_H5‐51 (12%). This novel finding of preferential V_H gene usage in half of the MCL cases may suggest an antigen driven process occurring in B‐cells expressing specific V_H genes, thus implicating that Ig specificity could be involved in mantle cell lymphoma development.     

Global distribution of Mycobacterium tuberculosis spoligotypes

We present a short summary of recent observations on the global distribution of the major clades of the Mycobacterium tuberculosis complex, the causative agent of tuberculosis. This global distribution was defined by data-mining of an international spoligotyping database, SpolDB3. This database contains 11708 patterns from as many clinical isolates originating from more than 90 countries. The 11708 spoligotypes were clustered into 813 shared types. A total of 1300 orphan patterns (clinical isolates showing a unique spoligotype) were also detected.     

Reasons for pregnancy termination, contraceptive habits and contraceptive failure among Swedish women requesting an early pregnancy termination

BACKGROUND: More than 30 000 legal abortions are performed every year in Sweden despite sexual education in schools, widespread youth-clinics and family planning services that are free of charge. The aim of this study was to investigate reasons for induced abortion, contraceptive habits and reasons for contraceptive failure among women presenting for induced abortion. METHODS: A questionnaire was administered to 591 Swedish-speaking women consecutively attending three different health care providers concerning an induced abortion during spring 2000. RESULTS: The response rate was 88% (n = 518). As many as 43%, among daily smokers 53%, had experienced one or more previous legal abortions. The majority of the women (97%) had discussed the decision about abortion with someone. The most cited reasons contributing to their decision were financial concerns, worries about the relationship and bad timing of the pregnancy. Though 85% had used contraception during the previous year, 36% of the women had not used any contraceptive method at the time of conception. The main reason given for not using contraception was the belief that they could not at that time become pregnant (35%). Ninety percent of the women planned to use contraception after the abortion. CONCLUSION: Women's decisions regarding induced abortion are multifactorial. One important reason was "poor economy". One out of three did not use any contraception, as they believed they could not become pregnant. Women presenting for induced abortion are a risk-group for further terminations. Counseling must include information about the fertile window, effective contraceptives and the emergency contraceptive pill.     

Self-reported reproductive outcome and implications in relation to use of care in women in rural Zimbabwe

BACKGROUND: In order to assess morbidity and health care utilization in developing countries, health interview surveys are often used. The aim of this paper is to explore morbidity, health care utilization during pregnancy and pregnancy outcome as reported by women in rural Gutu district, Zimbabwe. METHODS: The study was cross-sectional, performed 1992-93 in 12 villages selected at random. Women aged 15-44 years (n = 1213) were interviewed concerning their reproductive history, use of maternity care and complications during pregnancy/labor during their latest pregnancy. RESULTS: The perinatal mortality rate (PMR) for all the completed pregnancies (889 women had completed 3601 pregnancies) was 23/1000 total births. The attendance rate for antenatal care was high (94%). Elevated blood pressure was the most commonly reported late pregnancy complication, and a prolonged labor, i.e. 24 h or more, the most common complication during delivery. Out of women whose latest pregnancy did not end in an early or late abortion (n = 831) the cesarean section rate was 6.3%. The PMR was 8.4/1000 for their latest pregnancy. Institutional deliveries were preferred by the majority of women, with hospital and clinic deliveries constituting 58% and 27% of deliveries, respectively, while 15% delivered at home. Long-term complications were few, and only 14 (1.6%) women reported a current health problem, which they related to previous pregnancies. CONCLUSIONS: Antenatal attendance rate was high. The majority of women preferred institutional deliveries. Few women reported complications, which were not taken care of in the health service. Long-term complications related to previous pregnancies were few.     

Serum levels of citalopram and its main metabolites in adolescent patients treated in a naturalistic clinical setting

The prescribing of selective serotonin reuptake inhibitors for adolescents is extensive despite the fact that there are few pharmacokinetic (PK), efficacy, safety, or tolerability studies on this group. This study reports the PK findings from two trials in adolescents treated with citalopram (CIT) in naturalistic clinical settings: one retrospective and one prospective. The aim of our study was to describe serum concentrations of CIT, desmethylcitalopram (DCIT), and didesmethylcitalopram (DDCIT) (trough values in steady state) in adolescents in relation to daily dose and clinical information obtained from therapeutic drug monitoring request forms. Altogether, 44 patients younger than 21 years were scrutinized using this combined open-label approach.The main findings were that (1) there was a pronounced interindividual variability of serum CIT, DCIT, and DDCIT concentrations in all doses prescribed, in agreement with previous studies on adults; on correcting for dose, the coefficient of variance was about 50% for CIT, DCIT, and DDCIT; (2) the transformation of CIT to DCIT and of DCIT to DDCIT was similar within the dose range 20 to 60 mg/day; (3) there was a difference between the sexes on comparing the dose-corrected concentrations of CIT and DCIT, with girls presenting significantly higher values than boys; and (4) there was a strong dose-serum concentration relationship in three identified subgroups of adolescents: (a) nonsmokers (CIT, r(2) = 0.71; DCIT, r(2) = 0.81), (b) girls not taking oral contraceptives (CIT, r(2) = 0.75; DCIT, r(2) = 0.71,), and (c) girls in the last 14 days of the menstrual cycle (CIT, r(2) = 0.68; DCIT, r(2) = 0.64).In summary, the present study tentatively supports influences of sex, oral contraceptives, and smoking habits on the disposition of CIT in younger patients. Hence, future studies on CIT should assess these parameters.     

Butyl benzyl phthalate affects shoaling behavior and bottom-dwelling behavior in threespine stickleback

In this laboratory experiment, the effects on fish behavior caused by butyl benzyl phthalate (BBP) were of interest. We showed that shoaling behavior and bottom-dwelling behavior in threespine stickleback, Gasterosteus aculeatus, were altered as a result of exposure to 0.1 mg/L BBP. Threespine sticklebacks, collected from a freshwater population in central Norway, were exposed to BBP for 26 days. BBP was administered daily through the water. We found that exposed fish aggregated more into one single shoal than control fish. Further, the exposed fish spent more time at the bottom of the test aquarium than the control fish. From these results we conclude that the behavior traits aggregation and bottom-dwelling activity may be suitable and sensitive in detecting effects of BBP in threespine stickleback.