Prednisolone maintenance dose in relation to starting dose in the treatment of polymyalgia rheumatica and temporal arteritis. A prospective two-year study in 273 patients.

OBJECTIVE: To describe the maintenance dose and annual cessation rate of oral corticosteroids in relation to the starting dose in patients with polymyalgia rheumatica (PMR) and temporal arteritis (TA). METHODS: A prospective two-years observational study of 273 patients with PMR and TA followed by rheumatologists. RESULTS: Mean daily maintenance dose of prednisolone during the first and second year was 5.7 mg and 4.3 mg for PMR, 6.6 mg and 4.1 mg for TA, and 8.3 mg and 4.7 mg for PMR with TA. There was a strong association between the initial dose and maintenance dose. The rate of steroid cessation after two years in PMR was 24%, in TA 16%, and in PMR with TA 5%. CONCLUSION: Low initial dose of prednisolone is associated with low maintenance dose. This is important as the majority of patients with PMR and TA will be treated for more than two years.     

Feasibility of shock advice analysis during CPR through removal of CPR artefacts from the human ECG

Mechanical activity from chest compressions and ventilations during cardiopulmonary resuscitation (CPR) introduces artefact components into the electrocardiogram (ECG). CPR must therefore be discontinued for reliable shock advice analysis in automated external defibrillators. Reducing or eliminating this detrimental "hands-off" time by removing the CPR artefacts, should significantly improve the defibrillation success rate. The feasibility of this was tested by removing the CPR artefacts using a multichannel adaptive filter, the multichannel recursive adaptive matching pursuit (MC-RAMP) algorithm. Human ECG and reference channel data from episodes with both shockable and non-shockable underlying heart rhythms were recorded from 105 patients with out-of-hospital cardiac arrest. The performance of a shock advice algorithm was evaluated before and after artefact removal using the MC-RAMP algorithm. From a test set consisting of 92 shockable and 174 non-shockable episodes a sensitivity of 96.7% and specificity of 79.9% was achieved, an increase of approximately 15 and 13%, respectively, compared to no filtering. Good sensitivity was achieved, enabling ECG analysis during CPR that would reduce the hands-off time on patients with shockable rhythms. However, CPR artefact removal on non-shockable rhythms proved a more difficult problem. We need a better understanding of the physiological mixing of artefacts and the underlying heart rhythm and suggest clinical trials to investigate the nature of CPR artefacts further.     

Diurnal secretion of ghrelin, growth hormone, insulin binding proteins, and prolactin in normal weight and overweight subjects with and without the night eating syndrome

The regulatory peptide ghrelin has been proposed to help mediate both hunger and sleep. The neuroendocrine circadian patterns in the night eating syndrome (NES) have been distinguished by an attenuated nocturnal rise in the plasma concentrations of melatonin and leptin and a greater increase in the concentrations of cortisol. In this study we wanted to test the hypothesis that night eaters have disturbances in the circadian levels of ghrelin, growth hormone (GH) and associated regulatory peptides. In 12 female night eaters (6 normal weight and 6 overweight), and 25 healthy controls (12 normal weight and 13 overweight), blood was sampled over a 24-hour period. Four meals were served from 8 AM to 8 PM, and blood samples were drawn every second hour for determination of plasma ghrelin concentrations and GH by radioimmunoassay (RIA). Analysis of serum GH, IGF-1, IGFBP-3 and prolactin were performed by ELISA. In healthy normal weight subjects there was a slight but non significant nocturnal increase of ghrelin, whereas a more or less flat curve was observed for healthy overweight, NES normal weight and NES overweight patients. The RMANOVA analysis showed a significant independent lowering effect of overweight on the grand mean of ghrelin. No direct effects on NES normal weight and overweight subjects were found, but a near-significant interaction was found between healthy overweight and overweight NES subjects. There were independent significant lowering effects of overweight and NES on the serum GH levels. During the time course no changes in the serum levels of IGF-1 or IGFB-3 were observed. Independent significant lowering effects of overweight and NES on the levels of IGF-1 were detected, whereas a near significant reduction in the global levels of IGFBP-3 was observed in both NES groups. Finally, significant nocturnal changes were observed for serum levels of prolactin in all four subgroups. Grand mean levels tended to be higher in NES subjects whereas the opposite was observed in healthy overweight (ns). We conclude that in both NES groups and in healthy overweight subjects more or less attenuated ghrelin and GH secretions were observed, whereas divergent secretions were observed for prolactin.     

Time trends in socio-economic factors and risk of hospitalisation with infectious diseases in pre-school children 1985-2004: a Danish register-based study

The purpose of this study was to examine socio-economic differences in the risk of hospitalisation among children aged 0-5 years in Denmark from 1985 to 2004. All children born between 1985 and 2004 (n=1,278,286) were followed for hospital admissions for infectious diseases from the 29th day of life until the children reached the age of 6 years or the end of 2004, whichever came first. Information on parental socio-economic position (education, labour market attachment and household income) was gathered through record linkage with administrative registries. Infections were grouped into upper respiratory, lower respiratory, gastrointestinal, ear and fever infections. The data were analysed using Cox regression. Children of parents on sick leave or early retirement had an increased risk of being hospitalised with an infection compared with children of employed parents. A clear inverse educational gradient in risk of offspring hospitalisation was also found. From 1985 to 2004 the inverse associations between parental education and risk of hospitalisation grew stronger, whereas the comparatively weaker association between household income and risk of offspring hospitalisation decreased in magnitude. The association between socio-economic status and hospitalisation was strongest for lower respiratory, gastrointestinal and ear infections. This study documented a socially patterned hospitalisation of pre-school children in Denmark. Future studies should investigate possible explanations for the increased risk among children from families with low socio-economic status.     

From resistance to rescue – patients’ shifting attitudes to antihypertensives: A qualitative study

Objective. The objective of this study was to gain a deeper knowledge and understanding of experiences of antihypertensive drug treatment. Design. Interview study. Setting. A primary health care centre in western Sweden. Method. Qualitative interviews and analyses through systematic text condensation described by Malterud. Subjects. Ten informants in pharmacological treatment for high blood pressure (six men and four women). Main outcome measure. Experiences of hypertension drug treatment. Results. The findings revealed a process starting with resistance to drug treatment related to lack of control, side effects, and unwanted awareness of impaired health. These negative feelings then changed into a positive desire for lifestyle changes caused by a fear of cardiovascular disease which in turn changed the attitude towards drugs into seeing them as a rescue remedy and something normal and this then evoked health care trust. Conclusion. Despite initial resistance to treatment, the experience of antihypertensive drug treatment became more positive with time. Confidence in the health care system is important for adherence to treatment. General practitioners have a key role in this regard.Key Words: Attitude to health, health behaviour, hypertension, patient acceptance of health care, patient compliance, process, general practice, Sweden

• Hypertension is common and a well-known risk factor for diseases such as myocardial infarction or stroke.
• Initially, most patients are resistant to antihypertensives but attitudes change if they are well informed and if they have confidence in the health care system.
• Before treatment is started the individual''s gain in risk reduction for serious events should be considered.

     

Changes in guinea pig muscle histology in response to reduced mobility

Dorsiflexion of one hind foot has been prevented in guinea pigs by means of a light prosthesis. The gastrocnemius and soleus muscles of both hind legs have been removed after a period of 2 weeks, and the fiber cross-sectional areas of type 1 and 2 fibers in both muscles have been measured. Comparison of the values in normal and affected muscles shows that the limited reduction in free movement of the foot led to a significant atrophy in types 1 and 2 fibers in both muscles. The use of this simple prosthesis appears to have no effect on any other function of the leg except for the restriction of the lengthening of gastrocnemius and soleus muscles, and the results show that some of the hypotheses about the muscle atrophy seen in fully immobilized limbs cannot account for the changes observed in the present experiments and seem to be of limited validity.     

DNS-Gehalt von Lymphocyten und einkernigen Tumorzellen beim Morbus Hodgkin

Summary Thirteen lymph node biopsy specimens with Hodgkin's disease (six cases of the nodular sclerosis type; six cases of the mixed cellularity type; one case of the lympocytic depletion type) were studied with scanning cytophotometric measurements. The DNA content of small lymphocytes, large lymphocytes, atypical mononuclear cells and Hodgkin cells was measured. The sizes of the nuclei and mitotic indices were also measured. There were no lymphocytes with aneuploid DNA stemlines. Large lymphocytes showed proliferative activity which is possibly reactive, although its neoplastic character cannot be excluded. Hodgkin cells exhibited aneuploid values in seven cases and atypical mononuclear cells in only four cases. The nuclear sizes and the DNA content of the atypical mononuclear cells ranged between the values of lymphocytes and Hodgkin cells. The mixed cellularity type showed higher DNA values, more frequently occurrence of aneuploid stemlines and a higher frequency of mitotic figures than did the nodular sclerosis type. The results confirm the different grades of malignancy of the various histopathological categories of Hodgkin's disease.

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Abkürzungsverzeichnis c content - 2c diploid - DNS Desoxyribonukleinsäure - l.d. lymphocytenarmer Typ - m.c. mischzelliger Typ - n.s. nodulär sklerosierender Typ - s Standardabweichung     

Bone mass as referent for urinary hydroxyproline excretion: Age and sex-related changes in 125 normals and in primary hyperparathyroidism

Summary Fasting urinary hydroxyproline:creatinine ratio (OHPr:Cr) and bone mineral content of the forearm (BMC) were measured in 125 normals, 67 females and 58 males, aged 20–79 years, and in 15 patients with primary hyperparathyroidism. In normals, both variables were significantly correlated to age and sex. The interrelation of OHPr:Cr and BMC was studied in subgroups of normals who were supposedly in metabolic balance, that is, females aged 20–39 years (n=24) and males aged 20–49 years (n=29). In both sexes OHPr:Cr and BMC were positively correlated: r=0.60 and 0.58, respectively (P<0.001). On this basis, BMC correction of all OHPr:Cr values was undertaken now revealing a stable increased level of bone resorption per unit of bone mass in post-menopausal females. In males OHPr:Cr per unit of BMC remained unaltered throughout life. In primary hyperparathyroidism, in which increased bone resorption is inherent, the discriminatory power of OHPr:Cr was significantly improved when calculated per unit of BMC (P<0.001). These observations suggest that estimation of bone resorption by use of OHPr:Cr requires adjustment for differences in bone mass.