Visual function in Norwegian children aged 5–13 years with prenatal exposure to opioid maintenance therapy: A case–control study

Purpose: To assess various aspects of visual function in school children prenatally exposed to opioid maintenance therapy (OMT) and to explore possible outcome differences between prenatal methadone and buprenorphine exposure. Methods: In a cross-sectional case–control study, 63 children aged 5–13 years with prenatal OMT exposure were compared with 63 age- and gender-matched, non-exposed controls regarding important visual parameters, such as visual acuity, orthoptic status, refractive state, colour vision, and visual field. Results: The OMT-exposed children had significantly poorer visual acuity, both for the best eye, the worst eye and binocularly. Two children had mild visual impairment. Manifest strabismus was more frequent in the OMT group, 30%, vs. 4.8% in the control group. The most frequent types of strabismus were accommodative esotropia and intermittent exotropia. Manifest nystagmus was present in 10 (16%) of the exposed children compared to one among the non-exposed children. The accommodative amplitude was decreased in the OMT group compared to the controls. After adjusting for polydrug exposure and SGA (small-for-gestational-age), the between-group differences in visual acuity, strabismus, and nystagmus remained. The methadone-exposed children had poorer visual acuity, increased frequency of strabismus and a higher percentage of nystagmus, hypermetropia and astigmatism compared to the buprenorphine-exposed children. Conclusions: School-age children exposed to methadone or buprenorphine in utero had a higher prevalence of strabismus and nystagmus, and a lower visual acuity and accommodation amplitude. Buprenorphine exposure was associated with more favourable results than methadone exposure on most visual outcome measures and should be the preferred substance in OMT.publishedVersio

Mouse models for preeclampsia: disruption of redox-regulated signaling

The concept that oxidative stress contributes to the development of human preeclampsia has never been tested in genetically-defined animal models. Homozygous deletion of catechol-Omethyl transferase (Comt-/-) in pregnant mice leads to human preeclampsia-like symptoms (high blood pressure, albuminurea and preterm birth) resulting from extensive vasculo-endothelial pathology, primarily at the utero-fetal interface where maternal cardiac output is dramatically increased during pregnancy. Comt converts estradiol to 2-methoxyestradiol 2 (2ME2) which counters angiogenesis by depleting hypoxia inducible factor-1 alpha (HIF-1 alpha) at late pregnancy. We propose that in wild type (Comt++) pregnant mice, 2ME2 destabilizes HIF-1 alpha by inhibiting mitochondrial superoxide dismutase (MnSOD). Thus, 2ME2 acts as a pro-oxidant, disrupting redox-regulated signaling which blocks angiogenesis in wild type (WT) animals in physiological pregnancy. Further, we suggest that a lack of this inhibition under normoxic conditions in mutant animals (Comt-/-) stabilises HIF-1 alpha by inactivating prolyl hydroxlases (PHD). We predict that a lack of inhibition of MnSOD, leading to persistent accumulation of HIF-1 alpha, would trigger inflammatory infiltration and endothelial damage in mutant animals. Critical tests of this hypothesis would be to recreate preeclampsia symptoms by inducing oxidative stress in WT animals or to ameliorate by treating mutant mice with Mn-SOD-catalase mimetics or activators of PHD

Nutritional risk assessment for Hip fracture, A Case control study

The study was conducted at Oslo University Hospital, Norway. Patients were included from September 2009 until April 2011. In total 116 patients and 73 healthy non-fractured controls participated. The study has 3 parts. In the first part, we studied micronutrients and the risk of hip fracture in a case control study. In the second part, we conducted a randomized controlled nutrition intervention trial and finally, in the third part, we studied if micronutrients were associated with delirium in the acute phase of hip fracture in a case control study. We found that the micronutrients: vitamin A, C, D, E and K1 was associated with increased risk of hip fracture independent of BMI. However, low BMI was associated with hip fracture, but the variation in BMI ranged from 12- 34 in the patient group. Micronutrients correlated with bone turnover markers and there was a synergistic effect of 25(OH)D og vitamin K1 on the risk of hip fracture. We conclude that low micronutrients are associated with increased risk of hip fracture independent of BMI and that some of the association can be explained trough bone turnover markers. We found that vitamin K1 og 25(OH)D was significantly higher in the intervention group compared with control patients. However, there was no effect on bone turnover parameters between the two groups. The intervention prevented a fall in 25(OH)D that may have had other effects not measured by us. Low serum 25(OH) D was associated with increased risk of experiencing delirium. Undiagnosed and non treated malnutrition is common in the elderly in norway and spesiffic malnutrition may contribute in the association as to why Norway is world champions in hip fracture. About 50% of hip fracture patients experience a delirium during hospitalization for hip fracture. Low 25(OH)D may contribute to the high risk

The effect of a pre- and post-operative orthogeriatric service on cognitive function in patients with hip fracture. The protocol of the Oslo Orthogeriatrics Trial

<p>Abstract</p> <p>Background</p> <p>Hip fractures mainly affect older people. It is associated with high morbidity and mortality, and in particular a high frequency of delirium. Incident delirium following hip fracture is associated with an increased risk of dementia in the following months, but it is still not firmly established whether this is an association or a causal relationship. Orthogeriatric units vary with respect to content and timing of the intervention. One main effect of orthogeriatric care may be the prevention of delirium, especially if preoperative and postoperative care are provided. Thus, the aim of Oslo Orthogeriatric Trial, is to assess whether combined preoperative and postoperative orthogeriatric care can reduce the incidence of delirium and improve cognition following hip fracture.</p> <p>Methods/design</p> <p>Inclusion and randomisation will take place in the Emergency Department, as soon as possible after admission. All patients with proximal femur fractures are eligible, irrespective of age, pre-fracture function and accommodation, except if the fracture is caused by a high energy trauma or the patient is terminally ill. The intervention is pre-and post-operative orthogeriatric care delivered on a dedicated acute geriatric ward. The primary outcome measure is a composite endpoint combining the Clinical Dementia Rating Scale (CDR) and the 10 word memory task at four months after surgery. Secondary outcomes comprise incident delirium, length of stay, cognition, mobility, place of residence, activities of daily living and mortality, measured at 4 and 12 months after surgery. We have included 332 patients in the period 17^th September 2009 to 5^th January 2012.</p> <p>Discussion</p> <p>Our choice of outcome measures and our emphasis of orthogeriatric care in the preoperative as well as the postoperative phase will enable us to provide new knowledge on the impact of orthogeriatric care on cognition.</p> <p>Trials registration</p> <p>ClinicalTrials.gov NCT01009268</p