Seedetrakti ülaosa endoskoopiale suunatud patsientidel esinevate düspeptiliste sümptomite diagnostiline väärtus perearstipraksises

Düspepsiana käsitletav ülakõhuvalu ja/või seedetrakti ülaosast lähtuvad sümptomid esinevad üldpopulatsioonis sageli ning selle diagnoosimise ja raviga tegelevad nii perearstid, sisearstid kui ka gastroenteroloogid. Seedetrakti ülaosa endoskoopia on kaasajal tänu oma informatiivsusele düspeptiliste vaevuste tekkepõhjuse selgitamisel esmavaliku uuring

The diagnostic value of endoscopy and Helicobacter pylori tests for peptic ulcer patients in late post-treatment setting

BACKGROUND: Guidelines for management of peptic ulcer patients after the treatment are largely directed to detection of H. pylori infection using only non-invasive tests. We compared the diagnostic value of non-invasive and endoscopy based H. pylori tests in a late post-treatment setting. METHODS: Altogether 34 patients with dyspeptic complaints were referred for gastroscopy 5 years after the treatment of peptic ulcer using a one-week triple therapy scheme. The endoscopic and histologic findings were evaluated according to the Sydney classification. Bacteriological, PCR and cytological investigations and (13)C-UBT tests were performed. RESULTS: Seventeen patients were defined H. pylori positive by (13)C-UBT test, PCR and histological examination. On endoscopy, peptic ulcer persisted in 4 H. pylori positive cases. Among the 6 cases with erosions of the gastric mucosa, only two patients were H. pylori positive. Mucosal atrophy and intestinal metaplasia were revealed both in the H. pylori positive and H. pylori negative cases. Bacteriological examination revealed three clarithromycin resistant H. pylori strains. Cytology failed to prove validity for diagnosing H. pylori in a post-treatment setting. CONCLUSIONS: In a late post-treatment setting, patients with dyspepsia should not be monitored only by non-invasive investigation methods; it is also justified to use the classical histological evaluation of H. pylori colonisation, PCR and bacteriology as they have shown good concordance with (13)C-UBT. Moreover, endoscopy and histological investigation of a gastric biopsy have proved to be the methods with an additional diagnostic value, providing the physician with information about inflammatory, atrophic and metaplastic lesions of the stomach in dyspeptic H. pylori positive and negative patients. Bacteriological methods are suggested for detecting the putative antimicrobial resistance of H. pylori, aimed at successful eradication of infection in persistent peptic ulcer cases

Rheumatology training experience across Europe : Analysis of core competences

Publisher Copyright: © 2016 The Author(s). Copyright: Copyright 2019 Elsevier B.V., All rights reserved.Background: The aim of this project was to analyze and compare the educational experience in rheumatology specialty training programs across European countries, with a focus on self-reported ability. Method: An electronic survey was designed to assess the training experience in terms of self-reported ability, existence of formal education, number of patients managed and assessments performed during rheumatology training in 21 core competences including managing specific diseases, generic competences and procedures. The target population consisted of rheumatology trainees and recently certified rheumatologists across Europe. The relationship between the country of training and the self-reported ability or training methods for each competence was analyzed through linear or logistic regression, as appropriate. Results: In total 1079 questionnaires from 41 countries were gathered. Self-reported ability was high for most competences, range 7.5-9.4 (0-10 scale) for clinical competences, 5.8-9.0 for technical procedures and 7.8-8.9 for generic competences. Competences with lower self-reported ability included managing patients with vasculitis, identifying crystals and performing an ultrasound. Between 53 and 91 % of the trainees received formal education and between 7 and 61 % of the trainees reported limited practical experience (managing ≤10 patients) in each competence. Evaluation of each competence was reported by 29-60 % of the respondents. In adjusted multivariable analysis, the country of training was associated with significant differences in self-reported ability for all individual competences. Conclusion: Even though self-reported ability is generally high, there are significant differences amongst European countries, including differences in the learning structure and assessment of competences. This suggests that educational outcomes may also differ. Efforts to promote European harmonization in rheumatology training should be encouraged and supported.publishersversionPeer reviewe

Projekti "Veekaitsevööndite reostustundlikkuse ja kaldavööndi puhverribade rajamise vajalikkuse hinnangute kaardikihtide loomine" andmete arhiiv

Keskkonnainvesteeringute Keskuse rahastatud projekti “Veekaitsevööndite reostustundlikkuse ja kaldavööndi puhverribade rajamise vajalikkuse hinnangute kaardikihtide loomine” käigus loodud kaardikihtide arhiiv. Töö tulemus võimaldab kuluefektiivsemalt planeerida ja vähendada põllumajanduslikust hajureostusest tulenevat koormust veekogudes. Loodud kaardikihtide abil on võimalik kiiresti tuvastada probleemsed ja väga reostusohtlikud kaldavööndid, kuhu oleks soovituslik luua laiem puhverriba

The diagnostic value of endoscopy and <it>Helicobacter pylori </it>tests for peptic ulcer patients in late post-treatment setting

Abstract Background Guidelines for management of peptic ulcer patients after the treatment are largely directed to detection of H. pylori infection using only non-invasive tests. We compared the diagnostic value of non-invasive and endoscopy based H. pylori tests in a late post-treatment setting. Methods Altogether 34 patients with dyspeptic complaints were referred for gastroscopy 5 years after the treatment of peptic ulcer using a one-week triple therapy scheme. The endoscopic and histologic findings were evaluated according to the Sydney classification. Bacteriological, PCR and cytological investigations and 13C-UBT tests were performed. Results Seventeen patients were defined H. pylori positive by 13C-UBT test, PCR and histological examination. On endoscopy, peptic ulcer persisted in 4 H. pylori positive cases. Among the 6 cases with erosions of the gastric mucosa, only two patients were H. pylori positive. Mucosal atrophy and intestinal metaplasia were revealed both in the H. pylori positive and H. pylori negative cases. Bacteriological examination revealed three clarithromycin resistant H. pylori strains. Cytology failed to prove validity for diagnosing H. pylori in a post-treatment setting. Conclusions In a late post-treatment setting, patients with dyspepsia should not be monitored only by non-invasive investigation methods; it is also justified to use the classical histological evaluation of H. pylori colonisation, PCR and bacteriology as they have shown good concordance with 13C-UBT. Moreover, endoscopy and histological investigation of a gastric biopsy have proved to be the methods with an additional diagnostic value, providing the physician with information about inflammatory, atrophic and metaplastic lesions of the stomach in dyspeptic H. pylori positive and negative patients. Bacteriological methods are suggested for detecting the putative antimicrobial resistance of H. pylori, aimed at successful eradication of infection in persistent peptic ulcer cases.</p

Response of IgG1 and IgG2 subclasses to Helicobacter pylori in subjects with chronic inflammation of the gastric mucosa, atrophy and gastric cancer in a country with high Helicobacter pylori infection prevalence

Polarized immune response to Helicobacter pylori and induction of chronic inflammation may increase the risk of gastric atrophy and adenocarcinoma. We studied the association of the response of IgG1 and IgG2 antibodies to H. pylori with grade of gastric chronic inflammation and atrophy in a population with a high prevalence of H. pylori, and compared these data with the data obtained from the study of gastric cancer patients, as well as with the data for CagA positivity. Altogether, 114 persons from two adult population samples from Estonia and 45 consecutive gastric cancer patients were studied. All patients were positive for the H. pylori antibody determined by ELISA. Adenocarcinoma was classified histologically according to the Laurén's system. The response of the IgG subclasses to H. pylori (acid glycine-extracted whole cell proteins) was determined by ELISA and the results were compared with the ELISA results for the recombinant fragment of the CagA protein. Helicobacter pylori IgG level was lower in atrophic gastritis compared with nonatrophic gastritis (chronic inflammation) (p=0.001). In the group of cancer patients, the response of IgG and IgG1 was lower compared with both gastritis groups (p=0.01 and p=0.0002 for IgG, and p=0.001 and p=0.0005 for IgG1). IgG2 was lower for gastric cancer localized in the corpus (p=0.03). In conclusion, atrophic gastritis and gastric cancer were associated with a significant decline in IgG and IgG1 response to H. pylori compared with nonatrophic gastritis. Higher value of CagA antibodies was seen in gastric cancer and in gastric atrophy compared with nonatrophic gastritis; in gastric cancer patients, IgG1 response to H. pylori was correlated with CagA status

Ulriksdals slott under 350 år

Studierna har utgått från Ulriksdals slott, uppfört av Jacob De la Gardie för 350 år sedan. Som kungligt slott har Ulriksdal genomgått ombyggnader under 1600 - och 1700-talet, men präglas idag mest av Karl XVs omfattande omdaning på 1850-talet och Gustav VI Adolfs lika genomgripande förändringar på 1920-talet.Slottet har bjudit på rika studiemöjligheter av stilideal, planlösning, interiörgestaltning, snickerikultur och stormtekniska system från hela 350-årsperioden. Genom noggranna uppmätningar och inventeringar på plats kopplade till arkivstudier har slottets komplicerade förändringshistoria kunnat analyseras, Ulriksdals slott under 350 år är ett resultat av studierna i Restaureringskonst vid Kungl. Konsthögskolans Arkitekturskola läsåret 1994/95. Undervisningen är en vidareutbildning för arkitekter, antikvarier och andra med inriktning på byggnadsrestaurering. Målsättningen är att träna ett arbetssätt för analys av byggnaders historiska och tekniska kvaliteter samt att utveckla ett restaureringsideologiskt synsätt.</p

Vitamin D in women of reproductive age and during pregnancy - Focus on intake, status and adiposity

Vitamin D is attained either through synthesis in the skin by sun exposure or through diet. Vitamin D status is important for skeletal health but optimal vitamin D status may also be important in the development of other diseases such as type 2 diabetes, gestational diabetes, preeclampsia, and cancer. Circulating vitamin D is known to be decreased in obese compared to non-obese individuals. There is a lack of documented knowledge on vitamin D status and intake in Swedish women of reproductive age and during pregnancy. The aim of this thesis was to compare vitamin D status and intake between obese and normal-weight women. In a cross-sectional study in women of reproductive age and in a longitudinal study during pregnancy, blood samples, adipose tissue biopsies, and information on dietary intake were collected. Data on lifestyle including physical activity and sun exposure were also collected. Vitamin D status, measured as serum 25-hydroxyvitamin D [25(OH)D], was lower in obese women of reproductive age compared with normal-weight women. In contrast, circulating vitamin D-binding protein was higher in the obese women. Despite reporting a higher vitamin D intake, the obese pregnant women had lower serum 25(OH)D compared with normal-weight women in early pregnancy. A higher proportion of the obese compared with normal-weight women had 25(OH)D concentrations that might be defined as insufficient. Circulating 25(OH)D concentrations below 25 nmol/L were uncommon in both pregnant and non-pregnant women. Dietary vitamin D intake was between 7.2 and 8.8 µg/day during pregnancy and in non-pregnant obese and normal-weight women, and a major part did not reach national dietary recommendations. There were no major differences in vitamin D intake between obese and normal-weight women. Vitamin D and its metabolites were detected in adipose tissue and were localized in the lipid droplet in the adipocyte. The present studies show that Swedish obese women of reproductive age and during pregnancy have lower circulating 25(OH)D compared with normal-weight women but few had very low concentrations. However, what effects an increased circulating 25(OH)D would have on long-term health in obese individuals is yet to be studied. The fact that obese women had higher circulating vitamin D-binding protein is interesting and should be further examined to clarify why, and what impact that may have on the action of vitamin D. We found no evidence of a lower vitamin D intake in obese women, thus, the intake was not contributing to the lower circulating 25(OH)D. Many women do not reach the recommendations for vitamin D intake. Actions should be taken to improve dietary intake of vitamin D in women of reproductive age and during pregnancy, this might have future implications not only for women’s health but for generations to come. Intervention studies are urgently needed to explore the effect of vitamin D status and intake during pregnancy and in obese subjects