52 research outputs found
Determinants of high-sensitivity cardiac troponin T during acute exacerbation of chronic obstructive pulmonary disease: a prospective cohort study
<p>Abstract</p> <p>Background</p> <p>A high-sensitivity cardiac troponin T (hs-cTnT) concentration above the 99<sup>th</sup> percentile (i.e. 14âng/L) is common during Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) and associated with increased mortality. The objective of the study was to identify factors associated with hs-cTnT levels during AECOPD.</p> <p>Methods</p> <p>We included 99 patients with AECOPD on admission. As 41 patients had one or more repeat admissions, there were 202 observations in the final analysis. We recorded clinical and biochemical data, medication, spirometry, chest radiographs, and ECGs. The data were analysed for cross-sectional and longitudinal associations using ordinary least square as well as linear mixed models with the natural logarithm of hs-cTnT as the dependent variable.</p> <p>Results</p> <p>Mean age at inclusion was 71.5âyears, mean FEV<sub>1</sub>/FVC was 45%, and median hs-cTnT was 27.0âng/L. In a multivariable model there was a 24% increase in hs-cTnT per 10âyears increase in age (pâ<â0.0001), a 6% increase per 10âÎźmol/L increase in creatinine (pâ=â0.037), and a 2% increase per month after enrollment (pâ=â0.046). Similarly, the ratios of hs-cTnT between patients with and without tachycardia (heart rate âĽ100/min) and with and without history of arterial hypertension were 1.25 (pâ=â0.042) and 1.44 (pâ=â0.034), respectively. We found no significant association between arterial hypoxemia and elevated hs-cTnT.</p> <p>Conclusion</p> <p>Age, arterial hypertension, tachycardia, and serum creatinine are independently associated with the level of hs-cTnT on admission for AECOPD.</p
Participation and Inclusion of Children and Youth with Disabilities in Local Communities
This research aimed at strengthening the evidence base for interventions to promote the participation and inclusion of children and youth with disabilities in their communities. Four selected municipalities in four different regions of Norway participated. Focus group discussions (FGDs) were carried out in all four municipalities with service providers, children and youth with disabilities, and parents of children and youth with disabilities. The FGDs were used to develop a questionnaire to measure participation indicators. A survey was carried out among 186 children and youth, combining (a) random sampling of children and youth without disabilities and (b) invitations to all children and youth with disabilities, as registered by the municipalities. High-level analyses of the FGDs are presented, indicating the barriers and facilitators for participation for children and youth with disabilities, as well as requests for improvement of services to stimulate participation. The categories of family, technology, and volunteering were identified primarily as facilitators of participation, while school environment was primarily identified as a barrier. The survey measured four different aspects of perception of oneâs own participation. Data analyses revealed higher level of environmental barriers among children and youth with disabilities, and lower level of actual participation, satisfaction with oneâs own participation and oneâs own participation compared with that of peers.publishedVersio
Cardiac troponin T levels and exercise stress testing in patients with suspected coronary artery disease: the Akershus Cardiac Examination (ACE) 1 study
Whether reversible ischaemia in patients referred for exercise stress testing and MPI (myocardial perfusion imaging) is associated with changes in circulating cTn (cardiac troponin) levels is controversial. We measured cTnT with a sensitive assay before, immediately after peak exercise and 1.5 and 4.5Â h after exercise stress testing in 198 patients referred for MPI. In total, 19 patients were classified as having reversible myocardial ischaemia. cTnT levels were significantly higher in patients with reversible myocardial ischaemia on MPI at baseline, at peak exercise and after 1.5Â h, but not at 4.5Â h post-exercise. In patients with reversible ischaemia on MPI, cTnT levels did not change significantly after exercise stress testing [11.1 (5.2â14.9) ng/l at baseline compared with 10.5 (7.2â16.3) ng/l at 4.5Â h post-exercise, P=0.27; values are medians (interquartile range)]. Conversely, cTnT levels increased significantly during testing in patients without reversible myocardial ischaemia [5.4 (3.0â9.0) ng/l at baseline compared with 7.5 (4.6â12.4) ng/l, P<0.001]. In conclusion, baseline cTnT levels are higher in patients with MPI evidence of reversible myocardial ischaemia than those without reversible ischaemia. However, although cTnT levels increase during exercise stress testing in patients without evidence of reversible ischaemia, this response appears to be blunted in patients with evidence of reversible ischaemia. Mechanisms other than reversible myocardial ischaemia may play a role for acute exercise-induced increases in circulating cTnT levels
Impact of liver fibrosis and clinical characteristics on dose-adjusted serum methadone concentrations
Background
There is limited knowledge on the causes of large variations in serum methadone concentrations and dose requirements.
Objectives
We investigated the impact of the degree of liver fibrosis on dose-adjusted steady-state serum methadone concentrations.
Methods
We assessed the clinical and laboratory data of 155 Norwegian patients with opioid use disorder undergoing methadone maintenance treatment in outpatient clinics in the period 2016â2020. A possible association between the degree of liver fibrosis and dose-adjusted serum methadone concentration was explored using a linear mixed-model analysis.
Results
When adjusted for age, gender, body mass index, and genotypes of CYP2B6 and CYP3A5, the concentration-to-dose ratio of methadone did not increase among the participants with liver fibrosis (Coefficient: 0.70; 95% CI: â2.16, 3.57; P: 0.631), even among those with advanced cirrhosis (â0.50; â4.59, 3.59; 0.810).
Conclusions
Although no correlation was found between the degree of liver stiffness and dose-adjusted serum methadone concentration, close clinical monitoring should be considered, especially among patients with advanced cirrhosis. Still, serum methadone measurements can be considered a supplement to clinical assessments, taking into account intra-individual variations.publishedVersio
NT-proBNP independently predicts long term mortality after acute exacerbation of COPD â a prospective cohort study
Background
Cardiovascular disease is prevalent and frequently unrecognized in patients with chronic obstructive pulmonary disease (COPD). NT-proBNP is an established risk factor in patients with heart failure. NT-proBNP may also be released from the right ventricle. Thus serum NT-proBNP may be elevated during acute exacerbations of COPD (AECOPD). The prognostic value of NT-proBNP in patients hospitalized with AECOPD is sparsely studied. Our objective was to test the hypothesis that NT-proBNP independently predicts long term mortality following AECOPD.
Methods
A prospective cohort study of 99 patients with 217 admissions with AECOPD. Clinical, electrocardiographic, radiological and biochemical data were collected at index and repeat admissions and analyzed in an extended survival analysis with time-dependent covariables.
Results
Median follow-up time was 1.9 years, and 57 patients died during follow-up. NT-proBNP tertile limits were 264.4 and 909 pg/mL, and NT-proBNP in tertiles 1 through 3 was associated with mortality rates of 8.6, 35 and 62 per 100 patient-years, respectively (age-adjusted log-rank p<0.0001). After adjustment for age, gender, peripheral edema, cephalization and cTnT in a multivariable survival model, the corresponding hazard ratios for dying were 2.4 (0.95-6.0) and 3.2 (1.3-8.1) (with 95% confidence intervals in parentheses, p-value for trend 0.013).
Conclusions
NT-proBNP is a strong and independent determinant of mortality after AECOPD
High-sensitivity cardiac troponin T levels are increased in stable COPD
Objective To assess the distribution of high-sensitivity cardiac troponin T (hs-cTnT) concentrations in stable chronic obstructive pulmonary disease (COPD), and whether hs-cTnT is associated with pulmonary function.
Design Prospectively designed, cross-sectional study.
Setting Outpatient clinic of Norwegian teaching hospital and community-based setting.
Participants Sample of 101 stable COPD patients from the hospital's outpatient clinic and 120 individuals derived from a random general population sample.
Main outcomes Ratio of hs-cTnT in stable COPD patients compared with references from the general population. Change in ratio of hs-cTnT per unit increase of relevant covariables.
Results The crude geometric means of circulating hs-cTnT in the cases and the references were 7.75 and 3.01â
ng/l, respectively (pâ<0.001); that is, a relative ratio of 2.57 (95% CI 2.05 to 3.23). After adjustment for relevant confounders, this ratio was moderately attenuated to 1.65 (1.31â2.08). In the total study cohort, as well as among stable COPD patients, we found a significant positive association between hs-cTnT and interleukin-6 concentrations (pâ<0.001) and the presence of pathologic Q waves (p=0.023). Among stable COPD patients, one quartile increase in forced expiratory volume 1 was associated with a 39% decrease in hs-cTnT and patient category (Global Initiative of Obstructive Lung Disease classification 2011) was positively associated with hs-cTnT (p trend <0.001) after multivariate adjustment.
Conclusions Stable COPD is independently associated with higher hs-cTnT compared with randomly drawn subjects from the general population. In patients with stable COPD, higher hs-cTnT seems to be associated with immune activation and the severity of the disease
Participation and Inclusion of Children and Youth with Disabilities in Local Communities
This research aimed at strengthening the evidence base for interventions to promote the participation and inclusion of children and youth with disabilities in their communities. Four selected municipalities in four different regions of Norway participated. Focus group discussions (FGDs) were carried out in all four municipalities with service providers, children and youth with disabilities, and parents of children and youth with disabilities. The FGDs were used to develop a questionnaire to measure participation indicators. A survey was carried out among 186 children and youth, combining (a) random sampling of children and youth without disabilities and (b) invitations to all children and youth with disabilities, as registered by the municipalities. High-level analyses of the FGDs are presented, indicating the barriers and facilitators for participation for children and youth with disabilities, as well as requests for improvement of services to stimulate participation. The categories of family, technology, and volunteering were identified primarily as facilitators of participation, while school environment was primarily identified as a barrier. The survey measured four different aspects of perception of one’s own participation. Data analyses revealed higher level of environmental barriers among children and youth with disabilities, and lower level of actual participation, satisfaction with one’s own participation and one’s own participation compared with that of peers
Determination of equi-analgesic doses of inhaled methoxyflurane versus intravenous fentanyl using the cold pressor test in volunteers: a randomised, double-blinded, placebo-controlled crossover study
Background
Inhaled methoxyflurane for acute pain relief has demonstrated an analgesic effect superior to placebo. Data comparing methoxyflurane to an opioid are needed. The aim of this study was to determine the equi-analgesic doses of inhaled methoxyflurane vs i.v. fentanyl. Both drugs have an onset within minutes and an analgesic effect of 20â30 min.
Methods
Twelve subjects were included in a randomised, double-blinded, placebo-controlled crossover study with four treatments: placebo (NaCl 0.9%), fentanyl 25 Îźg i.v., fentanyl 50 Îźg i.v., or inhaled methoxyflurane 3 ml. The subjects reported pain intensity using the verbal numeric rating scale (VNRS) from 0 to 10 during the cold pressor test (CPT). The CPT was performed before (CPT 1), 5 min (CPT 2), and 20 min (CPT 3) after drug administration.
Results
Inhaled methoxyflurane and fentanyl 25 Îźg reduced VNRS scores significantly compared with placebo at CPT 2 (â1.14 [estimated difference in VNRS between treatment groups with 95% confidence interval {CI}: â1.50 to â0.78]; â1.15 [95% CI: â1.51 to â0.79]; both P<0.001) and CPT 3 (â0.60 [95% CI: â0.96 to â0.24]; â0.84 [95% CI: â1.20 to â0.47]; both P<0.001). There were no significant differences between the two drugs. Methoxyflurane had significantly higher VNRS scores than fentanyl 50 Îźg at CPT 2 (0.90 [95% CI: 0.54â1.26]; P<0.001) and CPT 3 (0.57 [95% CI: 0.21â0.94]; P<0.001).
Conclusions
Inhaled methoxyflurane 3 ml was equi-analgesic to fentanyl 25 Îźg i.v. at CPT 2. Both resulted in significantly less pain than placebo. Fentanyl 50 Îźg i.v. demonstrated analgesia superior to methoxyflurane.
Clinical trial registration
NCT0389480
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