The follow-up of patients of sixty-five years of age and younger with acute ischemic stroke and transient ischemic attacks, and elevated D-dimer levels in plasma

D-dimer levels in plasma, a degradation product of fibrin, have been shown to correlate with the severity of ischemic stroke. In order to investigate the outcome of patients with elevated D-dimer we have carried out a follow-up study of patients of 65 years of age and younger with acute ischemic stroke or transient ischemic attacks (TIA) admitted to our stroke unit from 1991 to 1992. Twenty-two of the 57 patients had elevated D-dimer levels in the plasma. High levels were associated with cardioembolic stroke. On follow-up after a mean of 12 years, 15 patients had died and six patients had suffered another stroke or TIA (three of whom were dead). Ten patients had suffered other cardiovascular events and seven of them were dead. We concluded that high levels of D-dimer in acute ischemic stroke patients on admission were associated with cardioembolic stroke and might have prognostic value for the development of further cardioor cerebrovascular events. Advanced age was found to be an independent risk factor

Clinical, diagnostic and immunological characteristics of patients with possible neuroborreliosis without intrathecal Ig-synthesis against Borrelia antigen in the cerebrospinal fluid

The diagnosis of neuroborreliosis is not always straightforward. Intrathecal immunoglobulin (Ig) synthesis against Borrelia antigen may not be detected, at least early in the disease course. Also other neurological and infectious diagnoses have to be considered. We have studied patients with clinical possible neuroborreliosis without intrathecal Ig synthesis against Borrelia antigen in the cerebrospinal fluid (CSF) (n=17). Diagnosis was based on typical clinical history and at least one of the following findings; mononuclear leucocytosis in the CSF (n=4); typical erythema migrans >5 cm in diameter in relation to debut of symptoms (n=8); prompt clinical response to antibiotic teratment (n=14). Also other possible diagnoses had to be excluded. Seventeen patients first investigated because of suspected neuroborreliosis but later confirmed with other diagnoses were used as controls. All patients had a lumbar puncture. Borrelia specific IFN-γ and IL-4 secretion was investigated in peripheral blood (PBL) and CSF with an ELISPOT assay. Polymerase chain reaction (PCR) was used to reveal any Borrelia antigen in the CSF. Six of 17 patients with possible neuroborreliosis showed high IFN-γ secretion in peripheral blood, otherwise we found no statistically significant differences between the groups. PCR did not reveal any Borrelia antigen in CSF. The diagnosis and treatment of possible but not confirmed neuroborreliosis is a clinical challenge. The clinical response to treatment may be the best option in these cases

Polymorphisms of GSTT1, GSTM1, and EPHX genotypes in patients with cryptogenic polyneuropathy: a case–control study

The aim of this study was to analyze whether polymorphisms for the null alleles of Glutathione S-Transferase Mu-1 (GSTM1), Glutathione S-Transferase Theta-1 (GSTT1), and a low-activity genetic variation of epoxide hydrolase exon three (EPHX*3) affect the risk of developing polyneuropathy. The enzymes of these genes are important in the metabolism of toxic compounds. Seventy-nine patients with cryptogenic polyneuropathy (equivalent to chronic idiopathic axonal neuropathy) and 398 controls were tested for the genetic polymorphism. Medical records were reviewed to collect data regarding clinical findings at diagnosis, and exposure data was collected via questionnaires. The odds ratios (ORs) for the null forms of GSTM1 and GSTT1 and the normal activity YY form of EPHX*3 were close to one except GSTT1, which reached 1.86. The highest risk of polyneuropathy was found in smokers with GSTT1 null, who had a 3.7 times increased risk. Interactions between genes were analyzed and confirmed the increased OR for GSTT1, which was strongest if the patients had the low-activity HH form of EPHX*3 (OR 2.37). Our hypothesis is that the GSTT1 null polymorphism may be related to an impaired metabolism of toxic substances that could lead to nerve damage in the peripheral nervous system

Subacute neuronopathy in a young man: a possible association with tetracycline treatment

A young man with subacute neuronopathy following tetracycline treatment is described. The symptoms started as a sensory dorsal root affection but by time also involved motor nerves. He developed a severe sensory ataxia with pseudoathetotic movements. Other possible aetiologies were scrutinized and excluded. Tetracycline induced neuronopathy is hitherto not reported in the literature. We propose a possible association between treatment with tetracycline and the development of sensory neuronopathy in this patient

Increased prevalence of celiac disease in idiopathic inflammatory myopathies

ObjectivesIdiopathic inflammatory myopathies (IIM) are often associated with other immune-mediated diseases or malignancy. Some studies have reported a high frequency of celiac disease in IIM. The aim of this study was to investigate the prevalence of celiac disease, systemic inflammatory diseases, and malignancy in a cohort of IIM patients, and estimate the incidence of IIM in the county of ostergotland, Sweden. Material and MethodsWe reviewed medical records and analyzed sera from 106 patients, fulfilling pathological criteria of inflammatory myopathy, for the presence of IgA antibodies against endomysium and gliadin. Antibody-positive patients were offered further investigation with small bowel biopsy or investigation for the presence of antibodies against antitissue transglutaminase (t-TG). The patients were classified according to Bohan and Peter or Griggs criteria. The presence of celiac disease, systemic inflammatory, and malignant diseases was documented. ResultsFour of 88 patients classified as IIM (4.5%) had biopsy-confirmed celiac disease, which is higher than the prevalence in the general population, detected with a similar screening procedure (0.53%). Thirty-three patients (38%) had a systemic inflammatory disease and five (5.7%) a malignancy. The incidence of confirmed IIM in the county of ostergotland was 7.3 per million/year. ConclusionsThe results highlight the high frequency of associated inflammatory and malignant diseases and confirm an increased prevalence of celiac disease in IIM.Funding Agencies|Linkoping University; Region Ostergotland</p

Longitudinal interferon-β effects in multiple sclerosis : differential regulation of IL-10 and IL-17A, while no sustained effects on IFN-γ, IL-4 or IL-13

Background: Recent studies in experimental models and in vitro indicate lowering of IL-17/Th17 as an important mechanism of interferon-beta (IFN-β) treatment in multiple sclerosis (MS). Material and methods: In this longitudinal study of MS patients (n = 25), spontaneous and myelin antigen-induced secretion of IL-4, IFN-γ and IL-10 (ELISPOT), mitogen stimulated secretion of IL-13 and IL-17A (ELISA) and circulating cytokine levels (Luminex) were recorded at inclusion and after 1.5, 3, 6 and 12 months of IFN-β treatment. Results: Early changes were noted for IL-4, while after one year of treatment the only recorded significant effects were a decrease in secreted IL-17A levels and an increase in IL-10 secreting cells. While IL-17A levels tended to be higher in non-responders (n = 8), the decrease in IL-17A levels seemed to be more pronounced in responders (n = 17) showing significantly lower IL-17A levels after one year as compared with non-responders. Conclusion: IFN-β treatment seems to mainly affect IL-17/IL-10-associated pathways rather than the IFN-γ/IL-4 axis.Funding Agencies|Biogen Idec||Network for Inflammation research||Swedish Foundation for Strategic Research||Swedish Association of Neurologically Disabled||County Council of Ostergotland||University Hospital of Linkoping and Lions Ostergotland||</p

Development of fine motor skills for 1,5 -3 year old children through art

Darba autors: Dace Dišlere Darba nosaukums: 1,5 - 3 gadīgu bērnu sīkās pirkstu un roku motorikas attīstīšana vizuālās mākslas nodarbībās. Darba apjoms: 43 lapas, 8 attēli, 1 tabula, 44 bibliogrāfiskie nosaukumi, 16 pielikumi. Darbs sastāv no 2 daļām: teorētiskās un empīriskās daļas. Atslēgas vārdi: vecumposms, sīkā pirkstu un roku motorika, vizuālās mākslas paņēmieni. Darba mērķis: – izpētīt vizuālās mākslas nodarbību iespējas bērnu sīkās pirkstu un roku motorikas attīstības veicināšanai. Darba uzdevumi: 1.Atlasīt un iepazīt pedagoģisko un psiholoģisko literatūru par pētāmo tēmu. 2.Izpētīt un sniegt 1,5- 3 gadīgu bērnu vecumposma attīstības raksturojumu. 3.Izpētīt bērnu sīkās pirkstu un roku motorikas veicināšanas nozīmi bērnu attīstībā. 4.Apzināt vizuālās mākslas nodarbību daudzveidīgās iespējas, bērnu sīkās pirkstu un roku attīstības veicināšanai. 5.Veikt pētījumu par bērnu interesi, spējām un prasmēm vizuālās mākslas nodarbībās. 6.Analizēt pētījuma gaitā iegūtos rezultātus un, balstoties uz tiem, izdarīt secinājumus un ieteikt priekšlikumus. Pētījuma metodes: Teorētiskās – pedagoģiskās, psiholoģiskās un metodiskas literatūras izpēte un atziņu apkopojums; Empīriskās – pedagoģiskā novērošana, SVID analīze, pedagogu aptaujas, sarunas ar bērniem, bērnu vecākiem, matemātiskās apstrādes metodes. Darba pirmajā daļā ir sniegts 1,5 - 3 gadīgu bērnu vecumposma attīstības raksturojums, apskatītas teorijas par bērnu sīkās pirkstu un roku motorikas nozīmi bērnu vispārīgajā attīstībā, vizuālās mākslas nodarbību plašās iespējas bērnu sīkās pirkstu un roku attīstības veicināšanā. Darba otrajā daļā, izmantojot dažādas pētījuma metodes, tika apkopota un analizēta informācija par pētījumu. Lai veicinātu bērnu sīkās pirkstu un roku motorikas attīstību vizuālās mākslas nodarbībās, tika izstrādāti metodiskie ieteikumi pirmsskolas skolotājiem.The author: Dace Dislere Title of Qualification paper: Development of fine motor skills for 1,5 -3 year old children through art. The volume of the work: 43 pages, 8 illustrations, 1 table, 44 bibliographic names, 16 appendices. It consists of two parts: theoretical part and empiric part. The key words: early preschool children, development of fine motor skills, art techniques. The aim of the research: to investigate different possibilities for art lessons and find out best techniques and activities for developing fine motor skills. The tasks of the work: 1.To pick out and get acquaintance with educational and psyclological kind of literature about the research theme. 2.To study age characteristics of early preschoolers. 3.To investigate the importance of fine motor skills in child development. 4.To find out the variety of art activities to develop children’s fine motor skills. 5.To make the research about children’s interests and skills in art activities. 6.To analyse the results which have been got during the research and to work out methodological suggestions for teacher’s at kindergarden. The methods of the research: Theoretical – the investigation of educational, psychological and methodical literature and the summary of conclusions; Empiric – educational observation, the analyses of the method (SWOT) – strenghts, weaknesses, opportunities and threats, conversations with colleagues, children and parents, mathematical processing methods. In the first part of the work the researcher gave early preschooler characteristics, put attention to the importance of fine motor skills development, to accentuate the posibilities of art to develop children’s fine motor skills. Ussing different research methods, the information of the research was summarized and analysed in the second part of the work. To improve children’s fine motor skills through art, the researcher worked out methodological suggestions for preschool teachers

Difficulties in identification of sleep disordered breathing in an outpatient clinic for heart failure– A case study

Sleep disordered breathing (SDB) is prevalent in patients with heart failure (HF). The clinical signs of newly diagnosed HF and untreated SDB may overlap and patients in need of SDB treatment can therefore be difficult to identify in patients participating in disease management programmes (DMP). The aim was to describe the care process of two patients with HF involved in a DMP, focusing on the difficulties to identify and initiate treatment of SDB.A prospective case study design was used to follow one male (70 yrs) and one female (74 yrs) patient during 18 months at a Swedish University hospital. It took 5 to 10 months from diagnosis of HF until optimal treatment was reached for their heart conditions and 12 to 17 months until SDB was treated. None of the patients complained of poor sleep, but suffered from fatigue. In the male SDB was detected by the wife’s complaints of her husband’s snoring, apnoeas and restless sleep. In the female, SDB was detected after a detailed assessment of fatigue which was shown to be sleepiness. After optimal treatment of HF but before imitation of SDB treatment both cases cardiac function improved. For the female case improvements also were found in the blood pressure. SDB treatment improved fatigue in both patients. Initiation of HF treatment and self-care routines, as well as identification of SDB is complex and time consuming. Treatment of HF and SDB can improve sleep, cardiac function as well as disturbing associated symptoms