Faktorer som påverkar uppvaknandet efter hjärtkirurgi - en kvantitativ tvärsnittsstudie

Bakgrund: Tidig extubation efter hjärtkirurgi förbättrar det postoperativa förloppet vilket leder till minskad morbiditet, mortalitet och vårdtid. Det innebär även kostnadseffektivitet och resurssparande. Syfte: Att jämföra patienter extuberade inom respektive efter fyra timmar avseende faktorer som kan påverka uppvaknandet efter CABG och/eller klaffkirurgi. Metod: En kvantitativ icke experimentell metod användes med utgångspunkt från ett extubationsprotokoll. Urvalet uppgick till 92 patienter, grupp 1 (n=43) extuberades inom och grupp 2 (n=49) efter fyra timmar. Resultat: Intuberad tid i studien var 248 minuter i median. Inga signifikanta skillnader i intraoperativ dos fentanyl eller ketobemidon/morfin/oxykodon givet innan extubation påvisades vid jämförelse av grupperna. Uppfyllda extubationskriterier skiljde sig signifikant mellan patienter i grupp 1 och 2. De faktorer som utmärkte sig och skulle kunna påverka tiden till extubation var otillräcklig egen respiration, nedsatt medvetandegrad, icke fullgod muskeltonus samt om patienten inte var lugn/kooperabel. Andra faktorer som visades påverka uppvaknandet var ålder, kreatinin, ECC-tid, anestesitid och sederad tid genom positiv korrelation med intuberad tid. Konklusion: Kartläggning av faktorer som orsakar fördröjd extubation kan bidra till åtgärder som minskar tiden till uppvaknande

Genetic prediction of postpartum diabetes in women with gestational diabetes mellitus

Aims: To examine whether genetic variants that predispose individuals to type 2 diabetes (T2D) could predict the development of diabetes after gestational diabetes mellitus (GDM). Methods: 13 SNPs (FTO rs8050136, CDKAL1 rs7754840 and rs7756992, CDKN2A/2B rs10811661, HHEX rs1111875, IGF2BP2 rs1470579 and rs4402960, SLC30A8 rs13266634, TCF7L2 rs7903146, PPARG rs1801282, GCK rs1799884, HNF1A rs1169288, and KCNJ11 rs5219) were genotyped in 793 women with GDM after a median follow-up of 57 months. Results: After adjustment for age and ethnicity, the TCF7L2 rs7903146 and the FTO rs8050136 variants significantly predicted postpartum diabetes; hazard ratio (95% confidence interval 1.29 (1.01-1.66) and 1.36 (1.06-1.74), respectively (additive model) versus 1.45 (1.01-2.08) and 1.56 (1.06-2.29) (dominant model)). Adjusting for BMI attenuated the effect of the FTO variant, suggesting that the effect was mediated through its effect on BMI. Combining all risk alleles to a weighted risk score was significantly associated with the risk of postpartum diabetes (hazard ratio 1.11, 95% confidence interval 1.05-1.18, p = 0.00016 after adjustment for age and ethnicity). Conclusions: The TCF7L2 rs7903146 and FTO rs8050136 polymorphisms, and particularly a weighted risk score of T2D risk alleles, predict diabetes after GDM. Further studies in other populations are needed to confirm our results. (C) 2012 Elsevier Ireland Ltd. All rights reserved

Factors explaining variance in perceived pain in women with fibromyalgia

BACKGROUND: We hypothesized that a substantial proportion of the subjectively experienced variance in pain in fibromyalgia patients would be explained by psychological factors alone, but that a combined model, including neuroendocrine and autonomic factors, would give the most parsimonious explanation of variance in pain. METHODS: Psychometric assessment included McGill Pain Questionnaire, General Health Questionnaire, Hospital Anxiety and Depression Rating Scale, Eysenck personality Inventory, Neuroticism and Lie subscales, Toronto Alexithymia Scale, and Multidimensional Health Locus of Control Scale and was performed in 42 female patients with fibromyalgia and 48 female age matched random sample population controls. A subgroup of the original sample (22 fibromyalgia patients and 13 controls) underwent a pharmacological challenge test with buspirone to assess autonomic and adrenocortical reactivity to serotonergic challenge. RESULTS: Although fibromyalgia patients scored high on neuroticism, anxiety, depression and general distress, only a minor part of variance in pain was explained by psychological factors alone. High pain score was associated with high neuroticism, low baseline cortisol level and small drop in systolic blood pressure after buspirone challenge test. This model explained 41.5% of total pain in fibromyalgia patients. In population controls, psychological factors alone were significant predictors for variance in pain. CONCLUSION: Fibromyalgia patients may have reduced reactivity in the central sympathetic system or perturbations in the sympathetic-parasympathetic balance. This study shows that a biopsychosocial model, including psychological factors as well as factors related to perturbations of the autonomic nervous system and hypothalamic-pituitary-adrenal axis, is needed to explain perceived pain in fibromyalgia patients

Balanced gene losses, duplications and intensive rearrangements led to an unusual regularly sized genome in Arbutus unedo chloroplasts

Completely sequenced plastomes provide a valuable source of information about the duplication, loss, and transfer events of chloroplast genes and phylogenetic data for resolving relationships among major groups of plants. Moreover, they can also be useful for exploiting chloroplast genetic engineering technology. Ericales account for approximately six per cent of eudicot diversity with 11,545 species from which only three complete plastome sequences are currently available. With the aim of increasing the number of ericalean complete plastome sequences, and to open new perspectives in understanding Mediterranean plant adaptations, a genomic study on the basis of the complete chloroplast genome sequencing of Arbutus unedo and an updated phylogenomic analysis of Asteridae was implemented. The chloroplast genome of A. unedo shows extensive rearrangements but a medium size (150,897 nt) in comparison to most of angiosperms. A number of remarkable distinct features characterize the plastome of A. unedo: five-fold dismissing of the SSC region in relation to most angiosperms; complete loss or pseudogenization of a number of essential genes; duplication of the ndhH-D operon and its location within the two IRs; presence of large tandem repeats located near highly re-arranged regions and pseudogenes. All these features outline the primary evolutionary split between Ericaceae and other ericalean families. The newly sequenced plastome of A. unedo with the available asterid sequences allowed the resolution of some uncertainties in previous phylogenies of Asteridae

The impact of gestational diabetes mellitus on pregnancy outcome comparing different cut-off criteria for abnormal glucose tolerance.

Abstract Objective. To examine pregnancy outcomes in relation to different categories of glucose tolerance during pregnancy. Design. Prospective observational cohort study. Setting. Patient recruitment and data collection were performed in four delivery departments in southern Sweden. Population. Women delivering during 2003-2005; 306 with gestational diabetes mellitus, 744 with gestational impaired glucose tolerance and 329 randomly selected controls. Methods. All women were offered a 75 g oral glucose tolerance test during pregnancy. On the basis of their capillary 2-hour plasma glucose concentrations, three groups were identified: gestational diabetes mellitus (>10.0 mmol/l), gestational impaired glucose tolerance (8.6-9.9 mmol/l) and controls (1 day and large-for-gestational age infant were 9.6 (1.2-78.0), 5.2 (2.8-9.6) and 2.5 (1.3-5.1), respectively. The increases in odds ratios for the gestational impaired glucose tolerance group were less pronounced but still significant for hypertension during pregnancy, induction of labor, large-for-gestational age infant and use of neonatal intensive care >1 day, with odds ratios (95% confidence interval) 2.0 (1.0-4.1), 1.8 (1.1-3.0), 2.1 (1.1-3.9) and 2.1 (1.1-3.8), respectively. Conclusions. These data indicate that even limited degrees of maternal hyperglycemia may affect the outcome of pregnancy

GENERAL ORAL GLUCOSE TOLERANCE TEST DURING PREGNANCY, AN OPPORTUNITY FOR IMPROVED PREGNANCY OUTCOME AND IMPROVED FUTURE HEALTH.

Gestational diabetes mellitus (GDM) is associated with a risk of adverse pregnancy outcome and is a predictor of subsequent diabetes. The aims of this work were to describe a reliable routine to diagnose abnormal glucose tolerance during pregnancy, to investigate women’s opinions of the specialist care provided, to determine the prevalence of diabetes one year after giving birth, and to elucidate the effect of abnormal glucose tolerance on pregnancy outcome and on the women’s future health. Routines for a general decentralised oral glucose tolerance test (OGTT) at antenatal clinics, with high quality and high compliance of the patients are described. Perinatal outcome was determined and compared for the years 1995-1999 and 2000-2003, and in two geographical areas with different screening routines (OGTT and random glucose measurements, RGM). The routine use of OGTTs identified twice as many cases of GDM as RGM. Those not identified with RGM were as affected. The women’s opinions of the extended care programme were analysed using a questionnaire. The results showed great satisfaction with the care provided, especially the sound knowledge of the staff. However, a desire for better preparation before the OGTT, better information flow and more information on normal pregnancy was expressed. Women delivered in 2003-2005 who had undergone an OGTT during pregnancy participated in a follow-up study 1-2 years after delivery. Different cut-off limits were used for 2-h capillary plasma glucose concentrations at OGTT during pregnancy. GDM >10.0 mmol/L, gestational impaired glucose tolerance (GIGT) 8.6-9.9 mmol/L, and a control group <8.6 mmol/L. At follow-up, 11% (n=160) of the GDM group, 4% (n=309) of the GIGT group and none of the controls had diabetes. When diagnosed with GIGT a retest was offered. Two-thirds of the women with diabetes after GIGT were found in the group diagnosed as having GDM after retest during pregnancy. Adverse pregnancy outcome was observed in both the GDM and GIGT groups compared with the controls. Women with previous GDM were more than 3 times as likely as a group to consume health care resources in a year after delivery (odds ratio 3.5, 95% CI 2.5-5.0), leading to an average 50% higher cost (p<0.001). Annual excess cost was apparent up to 7 years after childbirth (p<0.01). A general routine OGTT during pregnancy identifies women with GDM, providing the opportunity to improve the pregnancy outcome and to make lifestyle changes that can improve the future health of both mother and child

Relationships between diet and fitness apps use and body image concerns and eating disorder symptomology: A systematic review

This review aims to investigate the relationships between the use of commercial diet and fitness tracking technology (smartphone applications) and body image and eating concerns

Use of healthcare resources after gestational diabetes mellitus: A longitudinal case-control analysis.

AIMS: To analyse whether gestational diabetes mellitus (GDM) was associated with increases in healthcare utilisation after delivery. METHODS: A longitudinal case-control registry-based study of 579 women with GDM delivered in 1995-2001. Two controls for each case were selected from the Swedish National Board of Health and Welfare, matched for year of birth, year of delivery, and municipality of residence. Data regarding healthcare utilisation was provided by the Patients' Administrative System in Skåne County, Sweden, covering the period from the years of delivery up to year 2009. RESULTS: Women with previous GDM had higher mean number of contacts and total cost in the years after delivery as compared to controls, also when excluding utilisation related to subsequent pregnancies and childbirth. By year 2009, 31% of women with prior GDM were diagnosed with diabetes, compared to 1% of controls. Women diagnosed with diabetes were more likely to use health care (odds ratio 14.22, 95% confidence interval 5.87-34.45) controlling for age and time since delivery, whereas cases not diagnosed with diabetes did not differ from controls. The average annual cost of healthcare utilisation was 101% higher (p<0.001) for women with diabetes 10 years after delivery compared to controls. CONCLUSIONS: GDM was associated with higher healthcare utilisation postpartum for women who had a diabetes diagnosis. The results call for implementation of structured programmes to follow up women with GDM postpartum for early detection of diabetes and effective management, which may have the potential for improved health and savings in healthcare costs