Rheumatoid arthritis and birth outcomes: a Danish and Swedish nationwide prevalence study

Abstract. Nørgaard M, Larsson H, Pedersen L, Granath F, Askling J, Kieler H, Ekbom A, Sørensen HT, Stephansson O (Aarhus University Hospital, Denmark, Karolinska Institutet; Karolinska University Hospital, Solna; and Karolinska Institutet, Solna; Stockholm, Sweden). Rheumatoid arthritis and birth outcomes: a Danish and Swedish nationwide prevalence study. J Intern Med 2010; 268 : 329–337. Objectives. To examine the prevalence of preterm birth, infants with low Apgar score, small for gestational age (SGA) birth, stillbirth and congenital abnormalities in women with rheumatoid arthritis (RA) compared with women without RA. Design. Prevalence study. Setting. Combined Sweden and Denmark nationwide from 1994 to 2006. Subjects. We included 871 579 women with a first‐time singleton birth identified through population‐based healthcare databases. Main outcome measures. We compared the prevalence of preterm birth, low Apgar score (<7 at 5 min), SGA birth, stillbirth and congenital abnormalities amongst women with RA compared with women without RA using prevalence odds ratio (OR) with 95% confidence interval (95% CI), whilst controlling for maternal age, smoking, parental cohabitation and year. We stratified analyses by period of birth (1994–1997, 1998–2001 and 2002–2006). Results. Amongst 1199 women with RA, 7.8% gave birth between 32 and 36 gestational weeks (adjusted OR, 1.44; 95% CI, 1.14–1.82), 1.4% gave birth before gestational week 32 (adjusted OR, 1.55; 95% CI, 0.97–2.47), 1.6% had an infant with a low Apgar score (OR, 0.99; 95% CI, 0.95–1.65), 5.9% had an SGA birth (adjusted OR, 1.56; 95% CI, 1.2–2.01), 0.9% experienced stillbirth (adjusted OR, 2.07; 95% CI, 0.98–4.35) and 4.3% gave birth to an infant with congenital abnormalities (adjusted OR,1.32; 95% CI, 0.98–1.79). The OR for congenital abnormalities decreased from 2.57 (95% CI, 1.59–4.16) in 1994–1997 to 1.00 (95% CI, 0.64–1.56) in 2002–2006. Conclusions. Women with RA had a high prevalence of most adverse birth outcomes. This could be due to inflammatory activity, medical treatment or other factors not controlled for.     

Validation of the presence of comorbidities in a Danish clinical cohort of children with Tourette syndrome

Tourette syndrome (TS) is characterized by the presence of motor and vocal tics and is often accompanied by comorbid symptoms. We assessed the frequency of the comorbid symptoms obsessive-compulsive disorder obsessive-compulsive disorder, attention-deficit hyperactivity disorder (ADHD), rage attacks, sleeping disturbances, and depressive symptoms in a Danish clinical cohort of 314 children with TS using validated diagnostic instruments. For the assessment of symptoms of seasonal affective disorder and stuttering, we used a nonvalidated systematic interview. In total, only 10.2% of the children did not have any comorbid symptoms at all. If ADHD and/or obsessive-compulsive disorder were present, the rates of the comorbidities rage, symptoms of seasonal affective disorder, sleep disturbances, and depressive symptoms were significantly higher than if ADHD and/or obsessive-compulsive disorder were absent. The most severe tics were found in the group for which both ADHD and obsessive-compulsive disorder were present. Furthermore, there was a tendency toward more severe tics if other comorbid symptoms were present.     

Natural activity: an explorative study of the interplay between cage-birds and older people in a Swedish hospital setting

Aim.  The aim of this study was to describe the interaction between cage-birds and older people as it arises in spontaneous situations in a Swedish hospital ward setting.
Background.  Older people are at risk of being affected by mental fatigue because of various age-related reductions and disease. Mental fatigue manifests itself through a reduced ability to concentrate. The method of alleviating mental fatigue with the use of stimulating natural settings or animal-assisted activities is so far unexplored in Sweden and subsequently it is important to study the method in a Swedish context to implement it as a recognized nursing intervention in the care of older people.
Design.  The study had an explorative observational design, and was conducted at a geriatric ward with a consecutive selection of participants.
Method.  The observations were analysed using a constant comparative method influenced by Grounded Theory. 'Attention restorative theory' was used as the theoretical framework to guide the study.
Result.  Our findings indicate that animal-assisted therapy has a positive effect on involuntary attention and mental restoration, as well as on enhanced social behaviour among older people.
Relevance to clinical practice.  The result strengthens the assumption that animal companionship should be considered a beneficial nursing intervention for older people to prevent mental fatigue.     

Evidence for a release of brain-derived neurotrophic factor from the brain during exercise

Brain-derived neurotrophic factor (BDNF) has an important role in regulating maintenance, growth and survival of neurons. However, the main source of circulating BDNF in response to exercise is unknown. To identify whether the brain is a source of BDNF during exercise, eight volunteers rowed for 4 h while simultaneous blood samples were obtained from the radial artery and the internal jugular vein. To further identify putative cerebral region(s) responsible for BDNF release, mouse brains were dissected and analysed for BDNF mRNA expression following treadmill exercise. In humans, a BDNF release from the brain was observed at rest ( P < 0.05), and increased two- to threefold during exercise ( P < 0.05). Both at rest and during exercise, the brain contributed 70–80% of circulating BDNF, while that contribution decreased following 1 h of recovery. In mice, exercise induced a three- to fivefold increase in BDNF mRNA expression in the hippocampus and cortex, peaking 2 h after the termination of exercise. These results suggest that the brain is a major but not the sole contributor to circulating BDNF. Moreover, the importance of the cortex and hippocampus as a source for plasma BDNF becomes even more prominent in response to exercise.     

Magnetic resonance imaging of individual cerebral perfusion territories improves the diagnosis of embolic stroke

This case study demonstrates the feasibility and diagnostic value of the oblique-plane arterial spin labeling method to visualize individual perfusion territories in a patient with embolic stroke. The perfusion territories obtained with this technique differed significantly from the standard anatomical situation. Imaging findings suggested that all acute embolic lesions in both hemispheres had arisen from one symptomatic internal carotid artery stenosis.     

Cardiac allograft pathology: A clinicopathologic correlation

The relationships among cardiac allograft pathology, clinical course, and results of endomyocardial biopsies in 55 transplanted adult hearts from 43 autopsies and 12 retransplants were studied. The mean survival was 8.9 months. All patients received cyclosporin-A immunosuppressive therapy. Histologic assessment of left and right ventricles (LV and RV) and coronary arteries allowed comparison of the following regions of each ventricle: endocardium, subendocardium, myocardium, epicardium, epicardial coronary arteries, and intramyocardial arteries. Histologic and clinical features were compared using Fisher's exact test. Survival curve analysis (Wilcoxon's rank sum test) for each histologic feature was performed to define a statistical image of the significant pathologic features of allografts with longer survival. Pathologic changes were similar in LV and RV. Cellular infiltrate was equivalent transmurally in both ventricles. Subendocardial changes in the right ventricle generally reflected the same pathologic changes elsewhere in LV and RV. A history of at least two rejection episodes correlated with a perimyocytic pattern of LV fibrosis. Infiltrate and fibrosis in the epicardium and irregularity of the epicardial-myocardial junction and were more frequent in longer-surviving allografts and correlated with myocardial and coronary artery pathology. No significant correlation was found between subendocardial or myocardial pathological changes and coronary artery pathology. The statistical model proved to be a useful approach to the study of large numbers of clinicopathologic variables and gave results that were pathologically sound.     

Risk factors for venous thromboembolism in pre-and postmenopausal women

Introduction

Hemostasis in women is affected by changes of estrogen levels. The role of endogenous estrogens on risk of venous thromboembolism (VTE) remains unclear. The aim of this study was to investigate the importance of acquired and genetic risk factors for VTE in pre-and postmenopausal women.

Method

In a nationwide case-control study we included as cases 1470 women, 18 to 64 years of age with a first time VTE. The 1590 controls were randomly selected and matched by age to the cases. Information on risk factors was obtained by interviews and DNA-analyses. We used unconditional logistic regression to calculate odds ratios (ORs) with 95% confidence intervals (CIs).

Results

The ORs were generally of similar magnitude in pre- and postmenopausal women. The highest risk was for the combination of surgery and cast (adjusted OR 54.12, 95% CI 16.62-176.19) in postmenopausal women. The adjusted OR for use of menopausal hormone therapy was 3.73 (95% CI 1.86-7.50) in premenopausal and 2.22 (95% CI 1.54-3.19) in postmenopausal women. Overweight was linked to an increased risk and exercise to a decreased risk, regardless of menopausal status.

Conclusion

Menopausal status had only minor influence on the risk levels. Acquired transient risk factors conveyed the highest risks for VTE.     

Acute Fatal Pulmonary Vein Occlusion after Catheter Ablation of Atrial Fibrillation

BACKGROUND: In treatment of atrial fibrillation (AF) catheter radiofrequency isolation of the pulmonary veins (PVs) has proved to be highly successful. There have been several case reports regarding PV stenosis, however none of these have reported a fatal outcome. METHODS AND RESULTS: A 31-year-old man was referred to us for treatment of complications related to catheter ablation. According to the documentation from the hospital, the patient underwent segmental ostial PV isolation for treatment of AF. A few hours after the procedure, the patient developed dyspnoea, hemoptysis, and a high fever. The patient was first diagnosed as having pneumonia but five days later transesophageal echocardiography and pulmonal angiography revealed total occlusion of the left superior and inferior PVs. When we received the patient he underwent open-heart surgery, which showed thrombi in the orifices of the left sided PVs protruding into the left atrium. In each of the left sided PVs severe stenosis was seen in the bifurcation area. Thrombus material was removed followed by placement of two stents in each of the left sided pulmonary veins at the first bifurcations. However, the patient died 14 days after the ablation procedure. Selective autopsy of the left lung revealed diffuse alveolar damage, disseminated intravascular coagulation, multiple thrombi formation, and haemorrhagic infarctions. CONCLUSIONS: PV stenosis may occur very early after the ablation procedure. Delayed diagnosis can be fatal. The early stenosis may result in thrombus formation in the left atrium and PVs and in this case surgery should be considered.