18 research outputs found
Diagnostics and treatment of lentigo maligna melanoma in Denmark
No full textThe incidence of maligna melanoma has doubled in Denmark over the latest 30 years. Lentigo maligna melanomas (LMM) account for 10-26% of the melanomas in head and neck. LMM most often strike people over the age of 70 years and frequently occur in sun-exposed skin areas. LMM can be difficult to diagnose, since its clinical features are similar to benign skin lesions, solar lentigo and seborrhoeic keratosis. This review presents various methods for diagnosing and treating LMM. The specific method is chosen in dialogue with the patients, and overall health is an important factor when choosing an appropriate treatment
Diagnostics and treatment of lentigo maligna melanoma in Denmark
No full textThe incidence of maligna melanoma has doubled in Denmark over the latest 30 years. Lentigo maligna melanomas (LMM) account for 10-26% of the melanomas in head and neck. LMM most often strike people over the age of 70 years and frequently occur in sun-exposed skin areas. LMM can be difficult to diagnose, since its clinical features are similar to benign skin lesions, solar lentigo and seborrhoeic keratosis. This review presents various methods for diagnosing and treating LMM. The specific method is chosen in dialogue with the patients, and overall health is an important factor when choosing an appropriate treatment.</p
Chest x-ray findings in tuberculosis patients identified by passive and active case finding: A retrospective study
No full textBackground: Chest x-ray is central in screening and diagnosis of tuberculosis. However, sputum culture remains gold standard for diagnosis. Aim: To establish the rate of normal chest x-rays in tuberculosis patients found by spot sputum culture screening, and compare them to a group identified through passive case finding. Method: Chest x-rays from 39 culture-positive patients, identified by spot sputum culture screening in Copenhagen from 2012 to 2014, were included in the study (spot sputum culture group(SSC)). 39 normal chest x-rays from persons screened by mobile x-ray, and 39 chest x-rays from tuberculosis-patients identified through passive case finding(PCF) were anonymised and randomised. Two respiratory physicians and two radiologists assessed the chest x-rays. Results: The normal chest x-ray rate was higher in the non-tuberculosis control group (median = 32 (82.1%), range = 74.4% – 100%), compared to the SSC group (median = 7 (17.9%), range = 10.3% – 33.3%), and the PCF controls (median = 3(7.7%), range = 2.6% – 15.4%). In the SSC group 14 (35.9%) were categorized as normal by at least one study participant. Conclusion: A substantial minority of patients diagnosed with tuberculosis by spot sputum culture screening, and through passive case finding would not have been identified with chest x-ray alone, highlighting that a normal chest x-ray does not exclude pulmonary tuberculosis. Keywords: Tuberculosis, Chest x-ray changes, Passive case finding, Active case finding, Chest x-ray assessment, Normal chest x-ra
Major cardiovascular events in patients with severe COPD with and without asthma:a nationwide cohort study
No full textBackground Chronic low-grade inflammation as in asthma may lead to a higher risk of cardiovascular events. We evaluated whether patients with COPD and asthma have a higher risk of acute cardiovascular events than patients with COPD without asthma. Methods Nationwide multicentre retrospective cohort study of Danish outpatients with a specialist diagnosis of COPD with or without asthma. Patients with both COPD and asthma were propensity-score matched 1:2 to patients with COPD without asthma. The primary end-point was severe major adverse cardiac events (MACE), defined as mortal cardiovascular events and events requiring revascularisation or hospitalisation. Results A total of 52 386 Danish patients with COPD were included; 34.7% had pre-existing cardiovascular disease, and 20.1% had asthma in addition to their COPD. Patients with pre-existing cardiovascular disease were then propensity-score matched: 3690 patients with COPD and asthma versus 7236 patients with COPD without asthma, and similarly, for patients without pre-existing cardiovascular disease (6775 matched with 13 205). The risk of MACE was higher among patients with asthma and COPD versus COPD without asthma: hazard ratio (HR) 1.25 (95% CI 1.13–1.39, p<0.0001) for patients with pre-existing cardiovascular disease and HR 1.22 (95% CI 1.06–1.41, p=0.005) for patients without pre-existing cardiovascular disease. Conclusion Among patients with COPD, asthma as a comorbid condition is associated with substantially increased risk of cardiovascular events. The signal was an increased risk of 20–25%. Based on our study and other smaller studies, asthma can be considered a risk factor for cardiovascular events among COPD patients.</p
Effect of 10-Day Treatment with 50 mg Prednisolone Once-Daily on Haemostasis in Healthy Men—A Randomised Placebo-Controlled Trial
No full textSynthetic corticosteroids are widely used due to their anti-inflammatory and immunosuppressant effects. Their use has been associated with venous thromboembolism, but it is unknown whether thromboembolism has a causal relationship with corticosteroid treatment. In a randomised, double-blind, placebo-controlled trial in normal to overweight healthy men, the effect of the corticosteroid prednisolone on haemostasis using either 50 mg prednisolone or matching placebo once daily for ten days was investigated. The primary outcome was a change from baseline in the viscoelastic measurement maximal amplitude of clot in kaolin-activated thromboelastography (TEG). Changes from baseline in other TEG measurements, D-dimer, von Willebrand factor (VWF) antigen, and ristocetin cofactor activity (RCo), antithrombin, protein C, prothrombin, fibrinogen, INR, APTT, and platelet count were secondary outcomes. Thirty-four men participated in this study. Compared to placebo, prednisolone treatment did not affect maximal amplitude of clot (difference −0.77 (95% confidence interval (CI) −2.48, 0.94) mm, p = 0.37, missing: n = 2), but it altered VWF antigen (28%, p = 0.0004), VWF:RCo (19%, p = 0.0006), prothrombin (5%, p = 0.05), protein C (31%, p < 0.0001), antithrombin (5%, p = 0.013), and fibrinogen (−15%, p = 0.004). Thus, prednisolone treatment did not alter TEG-assessed maximal amplitude of clot, despite that it affected prothrombotic markers (increased prothrombin, VWF antigen, VWF:RCo, prothrombin, and decreased fibrinogen) and increased antithrombotic markers (protein C and antithrombin).</p
Fibrin degradation products and survival in patients with chronic obstructive pulmonary disease: a protocolized prospective observational study
No full textAbstract Background Patients with chronic obstructive pulmonary disease (COPD) have a high incidence of cardiovascular disease including thromboembolisms. Fibrin degradation products, like D-dimer, have been associated with death from all causes in healthy individuals and COPD patients. We aimed to determine the (i) association between D-dimer levels and all-cause mortality and time being alive and out of a hospital, (ii) possible modifying effect of anticoagulant treatment,, and (iii) distribution of D-dimer in patients with moderate to severe COPD. Methods Results of routinely measured stable phase D-dimer samples from COPD-outpatients at Copenhagen University Hospital – Herlev and Gentofte, COPD-outpatient clinic were collected using the Danish registries. These were used to examine whether COPD-patients with a D-dimer level in the upper quartile, had a higher risk of death from all causes within 365 days. Results In the unadjusted Cox proportional hazards regression we found an association between high D-dimer and all-cause mortality: Hazard ratio (HR): 2.3 (95% Confidence Interval (CI) 1.1–4.7). In the fully adjusted regression, the HR was 1.8 (CI 0.8–3.9). We did not find any interaction between D-dimer and anticoagulant or antiplatelet therapy. For the secondary outcome, proportion of days alive and out of hospital in 365 days (pDAOH), the unadjusted multiple linear regression had an association between high D-dimer level and pDAOH: -2.7% points (pp) (CI -3.9 pp - -1.5 pp), which was attenuated to -1,7pp (-2.9pp – -0.4pp) in the fully adjusted regression. Conclusions In patients with moderate to severe COPD, patients with a high level of D-dimer were more likely to die; however, the signal was not strong in the adjusted analyses and our results do not support unselected risk stratification with D-dimer in COPD-outpatients
Additional file 1 of Fibrin degradation products and survival in patients with chronic obstructive pulmonary disease: a protocolized prospective observational study
No full textAdditional File 1: Definition of diagnoses according to International Classification of Disease (ICD-10) codes and definition of treatments according to Anatomical Therapeutic Chemical (ATC)-codes. Description of data: A table containing definition of diagnoses (ICD-codes) and treatments (ATC-codes)
Thrombelastography and Conventional Coagulation Markers in Chronic Obstructive Pulmonary Disease:A Prospective Paired-Measurements Study Comparing Exacerbation and Stable Phases
No full textChronic Obstructive Pulmonary Disease (COPD) exacerbation is known for its substantial impact on morbidity and mortality among affected patients, creating a significant healthcare burden worldwide. Coagulation abnormalities have emerged as potential contributors to exacerbation pathogenesis, raising concerns about increased thrombotic events during exacerbation. The aim of this study was to explore the differences in thrombelastography (TEG) parameters and coagulation markers in COPD patients during admission with exacerbation and at a follow-up after discharge. This was a multi-center cohort study. COPD patients were enrolled within 72 h of hospitalization. The baseline assessments were Kaolin-TEG and blood samples. Statistical analysis involved using descriptive statistics; the main analysis was a paired t-test comparing coagulation parameters between exacerbation and follow-up. One hundred patients participated, 66% of whom were female, with a median age of 78.5 years and comorbidities including atrial fibrillation (18%) and essential arterial hypertension (45%), and sixty-five individuals completed a follow-up after discharge. No significant variations were observed in Kaolin-TEG or conventional coagulation markers between exacerbation and follow-up. The Activated Partial Thromboplastin Clotting Time (APTT) results were near-significant, with p = 0.08. In conclusion, TEG parameters displayed no significant alterations between exacerbation and follow-up.Keywords: COPD; exacerbation; thrombelastographyChronic Obstructive Pulmonary Disease (COPD) exacerbation is known for its substantial impact on morbidity and mortality among affected patients, creating a significant healthcare burden worldwide. Coagulation abnormalities have emerged as potential contributors to exacerbation pathogenesis, raising concerns about increased thrombotic events during exacerbation. The aim of this study was to explore the differences in thrombelastography (TEG) parameters and coagulation markers in COPD patients during admission with exacerbation and at a follow-up after discharge. This was a multi-center cohort study. COPD patients were enrolled within 72 h of hospitalization. The baseline assessments were Kaolin-TEG and blood samples. Statistical analysis involved using descriptive statistics; the main analysis was a paired t-test comparing coagulation parameters between exacerbation and follow-up. One hundred patients participated, 66% of whom were female, with a median age of 78.5 years and comorbidities including atrial fibrillation (18%) and essential arterial hypertension (45%), and sixty-five individuals completed a follow-up after discharge. No significant variations were observed in Kaolin-TEG or conventional coagulation markers between exacerbation and follow-up. The Activated Partial Thromboplastin Clotting Time (APTT) results were near-significant, with p = 0.08. In conclusion, TEG parameters displayed no significant alterations between exacerbation and follow-up.</p
Additional file 3 of Fibrin degradation products and survival in patients with chronic obstructive pulmonary disease: a protocolized prospective observational study
No full textAdditional File 3: Full information on the multiple linear regressions for pDAOH. Description of data: A table containing the full information in the multiple linear regression models mentioned in the manuscript
Additional file 4 of Fibrin degradation products and survival in patients with chronic obstructive pulmonary disease: a protocolized prospective observational study
No full textAdditional File 4: Full information on the multiple linear regressions for the participants with 365 days possible follow-up. Description of data: A table containing the full information in the multiple linear regression models for the participants with 365 days possible follow-up, with the unit days
