Danish medical journal
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Danish medical journal · Apr 2018
ReviewTourette syndrome in a longitudinal perspective. Clinical course of tics and comorbidities, coexisting psychopathologies, phenotypes and predictors.
Tourette syndrome (TS) is a childhood onset neurodevelopmental disorder characterised by motor and vocal tics and frequent associated comorbidities. The developmental trajectory of tic shows tic-onset in the age of 4-6, peak in the age of 10-12 and decline during adolescence, although only few and small longitudinal studies form the basis of this evidence. Recent studies suggest that comorbid obsessive-compulsive disorder (OCD), attention deficit-hyperactivity disorder (ADHD) and coexisting psychopathologies tend to persist and become more dominant in adolescence. ⋯ Comorbidities and coexisting psychopathologies were found in 63% at follow-up, whereas 37% had pure TS. Conclusion: The clinical course of TS during adolescence was confirmed, with solid evidence, with decline in tics, OCD and ADHD severity. We provide evidence of considerable coexisting psychopathologies requiring clinical support and partial remissions and subthreshold symptoms requiring monitoring and clinical guidance to assist the young adults in promoting a healthy transition into early adulthood. Furthermore we provide predictors for the clinical course of TS to be used in the preventive efforts, early intervention and allocation of resources improving quality of life for the children and their families.
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Danish medical journal · Apr 2018
ReviewMortality and morbidity in patients with osteogenesis imperfecta in Denmark.
Ostegenesis imperfecta (OI) is a hereditary disease of the connective tissue caused by mutations to, mainly, the genes that are involved in the biosynthesis of collagen type 1. Patients are grouped according to clinical severity and mode of inheritance according to Sillence's classification (originally 1979, updated 2014). According to our data, the population prevalence of OI in Denmark was 10.3 per 100,000, with 575 patients registered with an OI diagnosis in the National Patient Register and alive at the end of 2012 out of a total population of 5,602,628 persons. ⋯ We corrected for this increased risk by using a competing risk regression model. We found that the OI population had increased relative risk of mitral valve regurgitation (sub hazard ratio (SHR) 6.3), aortic valve regurgitation (SHR 4.5), atrial fibrillation/flutters (SHR 1.7) and heart failure (SHR 2.3) compared to the reference population. There was no difference in the risk of arterial aneurisms or arterial dissections. Conclusion: Patients with OI have increased risk of valvulopathies, atrial arrhythmias and heart failure when compared to the reference population, even after adjusting for risk factors for these car-diovascular diseases - indicating that the quantitative or qualitative defects of collagen type 1 synthesis seen in OI influence the risk of these cardiovascular diseases in patients with OI.
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Danish medical journal · Apr 2018
ReviewSunscreen use at Danish beaches and how to improve coverage.
Exposure to ultraviolet radiation (UVR) from the sun is the main risk factor for development of skin cancer. The incidence of skin cancer in Denmark and worldwide is high and increasing. The overall aim was to achieve basic knowledge about sun protection with sunscreen among beachgoers in Denmark. ⋯ After a single application, either as at the beach or with the use of a handful of sunscreen, about one fifth of the total accessible skin was left without sunscreen. After double application only about a 9% of the accessible skin was left uncovered. As especially missed areas are at risk of getting sunburned double application seems to be the better of the two tested strategies to improve coverage.
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Iron deficiency and anaemia in the puerperium are associated with several important clinical consequences, most prominently physical fatigue. Current treatment practice with oral iron supplementation is associated with gastrointestinal side-effects and subsequent poor compliance. Red blood cell transfusion is also widely used to treat severe postpartum anaemia, though accumulating evidence questions its risk-benefit ratio. ⋯ The difference in biochemical markers was larger than the patient-reported outcomes in the first week. A larger trial is needed to determine whether a high single-dose iron infusion is non-inferior to red blood cell transfusion in severe postpartum anaemia. The third study compared iron concentration in breast milk in a randomised sample of women receiving high single-dose iron infusion or oral iron. A high single-dose iron infusion lead to a transient increase in the iron concentration in breast milk, which remained within the normal range. In conclusion, iron isomaltoside seems to be associated with improved patient-reported outcomes compared to oral iron treatment, and in severe postpartum anaemia intravenous iron seems promising as an alternative to red blood cell transfusion.
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Danish medical journal · Apr 2018
ReviewDepression, stroke, and dementia in patients with myocardial infarction.
The connection between the heart and mind has been studied since Sir William Harvey observed more than 350 years ago that negative emotions adversely affect the heart. Today, we know that diseases of the mind can affect the heart and, conversely, that heart diseases can cause both physical and mental diseases of the brain. To explore this relation further, we examined how previous depression affects survival in patients with myocardial infarction (MI) (study II), and how the occurrence of MI affects the risk of ischemic and hemorrhagic stroke (study III) and dementia (study IV). ⋯ Compared with the general population cohort, MI patients were not at increased risk of all-cause dementia (adjusted hazard ratio = 1.01, 95% CI 0.98-1.03). In subgroups of dementia, we observed no substantial association with Alzheimer's disease (adjusted hazard ratio = 0.92, 95% CI 0.88-0.95) or other dementias (adjusted hazard ratio = 0.98, 95% CI 0.95-1.01). However, patients with MI had an increased risk of vascular dementia (adjusted hazard ratio = 1.35, 95% CI 1.28-1.43). In conclusion, we found that preceding depression was associated with moderately increased mortality after MI, and that was associated with an increased risk of stroke and vascular dementia, but not dementia from other causes.