Morbidity and childbirth in myeloproliferative neoplasms

Myeloproliferative neoplasms (MPN) are a family of chronic hematologic cancers, characterized by excess proliferation of myeloid cell lineages, or fibrosis of the bone marrow. Patients with MPN generally have a long expected survival. To elucidate morbidities during the disease course, e.g. second malignancies and infections, and outcome and prognosis of pregnancy and childbirth, we performed four large population-based cohort studies based on data from Swedish health registers, and compared outcomes to those of matched controls. We found that patients with MPN are at increased risk of second cancers, both solid and hematologic. The hazard ratio (HR) of developing a solid cancer was 1.6 (I.5-1.7), where skin cancers had the largest risk increase, but cancers of the brain, lung, pancreas, kidney and endocrine organs were also significantly increased. Patients with MPN also had a twofold risk of infections, HR 2.0 (1.9-2.0), leading to hospitalization or death compared to controls. An increase was evident in all subtypes of MPN, but significantly higher in patients with primary myelofibrosis. Among women with MPN, there were 342 pregnancies beyond gestational week 22/28 in women with MPN in Sweden 1973-2018. Preterm birth, in particular iatrogenic preterm birth, was significantly increased, but not thrombosis, bleeding or other obstetric complications. Low birthweight was similarly increased to preterm birth, but there was no increase in low birthweight babies in pregnancies with term delivery. The incidence of childbirth during the last decade was 12.2 per 100,000 childbirths. In women with MPN birthrates were reduced by 22%, HR 0.78 (0.67-0.90) compared to matched controls. In a subgroup analysis, the HR of childbirth was not reduced in patients with essential thrombocythemia. The rate of miscarriage was not statistically significantly increased, HR 1.25 (0.89-1.76.) Stillbirth was significantly more common in MPN patients prior to the MPN diagnosis, (p=0.013). In conclusion, there is significant morbidity in the MPN population, with increased risk of second cancers and infections. Pregnancy outcomes are generally better than previously anticipated, however there is an increased risk of preterm birth, and birthrates in MPN are lower than in the general population

The Sleepy Teenager – Diagnostic Challenges

The sleepy teenager puts the doctor in a, often tricky, situation where it must be decided if we deal with normal physiology or if we should suspect pathological conditions. What medical investigations are proper to consider? What differential diagnoses should be considered in the first place? And what tools do we actually have? The symptoms and problems that usually are presented at the clinical visit can be both of medical and psychosocial character - and actually they are often a mixture of both. Subsequently, the challenge to investigate the sleepy teenager often includes the examination of a complex behavioral pattern. It is important to train and develop diagnostic skills and to realize that the physiological or pathological conditions that can cause the symptoms may have different explanations. Research in sleep disorders has shown different pathological mechanisms congruent with the variations in the clinical picture. There are probably also different patterns of involved neuronal circuits although common pathways may exist. The whole picture remains to be drawn in this interesting and challenging area

Släktvapenrätt – om dess ursprung och framväxt i Sverige

Släktvapen har fungerat som ett identifikationsmedel i Sverige och Europa sedan medeltiden, ursprungligen främst i sigill och på sköldar. Hur ett vapen får utformas ges av heraldiska normer – heraldik är läran om vapenmärken. Ett vapen bestäms utifrån dess innehåll, till skillnad från varumärken som bestäms av dess yttre form. Tack vare detta system har släktvapen från 1100-talet överlevt in i modern tid. Denna uppsats ämnar utreda hur den heraldiska släktvapentraditionen uppstod, vad den innebär och hur den har utvecklats i Sverige, ur ett juridiskt perspektiv. Släktvapenrätten avhandlades först av konciliatorn Bartolus de Saxoferrato i sitt verk Tractatus de Insigniis et Armis 1358, men uppkom under 1100-talet i Västeuropa i samband med bland annat korstågen. Den idélära som formulerades om vapenbruk innebar bland annat en ensamrätt till vapen som kunde göras gällande när annan använde sig av likadant vapen på ett menligt sätt mot din person. Ett släktvapen ansågs vara en förlängning av din person på samma sätt som ett namn. Med universitetens framväxt spreds den romerska rätten i Europa. Efter Alsnö stadga ca. 1280 fick svensk adel en egen stiftelseurkund. Släktvapenrätten i Sverige kom i stor utsträckning att präglas av adeln och adelns intressen. Adliga vapen skiljer sig från borgerliga vapen genom vissa attribut såsom användande av öppen hjälm till skillnad från stängd hjälm. Det har dock alltid varit fritt vem som helst att anta ett vapen. 1762 infördes en förordning som förbjöd ofrälse att föra vapen med adliga attribut mot risk att böta 500 daler silvermynt som en reaktion mot att ofrälse i allt större omfattning använde adliga vapen. Från åren efter förordningens införande finns två kända rättsfall: Laurin-fallet, där häradshövding Laurin undslapp böter på grund av ett missförstånd om sin börd, och von Sydow-fallet där von Sydow ansågs tillhöra adel men frågan om ensamrätt till vapnet inte prövades. 1762 års förordning har inte upphävts och har ansetts gällande framgent. 2009 fann Patent- och besvärsrätten att ensamrätt till släktvapen inte inbegrep skydd mot registrering av ett heraldiskt likt varumärke. Domstolen tillade däremot att släktvapen undantagsvis skulle kunna vara skyddat mot registrering av varumärke analogivis, genom att vara ägnat att uppfattas som annans släktnamn. 1762 års förordning ansågs dock inte vara tillämplig i målet. Sammanfattningsvis lyser skydd för släktvapen med sin frånvaro i dagens Sverige

VACCINATION AGAINST SWINE FLU CAUSED NARCOLEPSY IN SEVERAL EUROPEAN COUNTRIES

Publisher Copyright: © 2020 Boström I., Lindberger O., Partinen M., Landtblom A.M. All Rights Reserved.Narcolepsy is a rare sleeping disorder that gives sleep onset rapid eye movement periods and excessive daytime sleepiness. It is divided into two subgroups, narcolepsy type 1 where there also is orexin deficiency and cataplexy and narcolepsy type 2 that lack these features. Narcolepsy type 1 is assumed to be an autoimmune disease with destruction of orexin-producing cells. The pathology behind is unclear. There is a strong association to a class II HLA allele, HLADQB1*06:02 and the H1N1-virus and streptococcal infections has also been associated with narcolepsy. The severity of narcolepsy differs between patients from those who can manage their disease without medication to those who has a severe impact on their everyday life. There is a diagnostic delay between the onset of symptoms and time for diagnosis that in some cases can be more than a decade. The global mean prevalence is 30 per 100 000 inhabitants. The incidence in children in northern Europe has risen since 2010. An early study of the 2009 H1N1 influenza A pandemic indicated a high mortality and prompted efforts to rapidly come up with a vaccine. One of these was Pandemrix that was the most widely used in Europe and 61 % of the inhabitants in Sweden was vaccinated. Studies have shown an increased incidence of narcolepsy type 1 in European countries that had used Pandemrix, but no increased risk was seen in countries that had used other vaccines than Pandemrix.Peer reviewe

Inventory study of an early pandemic COVID- 19 cohort in South-Eastern Sweden, focusing on neurological manifestations

Background Neurological manifestations in patients with COVID-19 have been reported previously as outcomes of the infection. The purpose of current study was to investigate the occurrence of neurological signs and symptoms in COVID-19 patients, in the county of 6sterg\uf6tland in southeastern Sweden. Methods This is a retrospective, observational cohort study. Data were collected between March 2020 and June 2020. Information was extracted from medical records by a trained research assistant and physician and all data were validated by a senior neurologist. Results Seventy-four percent of patients developed at least one neurological symptom during the acute phase of the infection. Headache (43%) was the most common neurological symptom, followed by anosmia and/or ageusia (33%), confusion (28%), hallucinations (17%), dizziness (16%), sleep disorders in terms of insomnia and OSAS (Obstructive Sleep Apnea) (9%), myopathy and neuropathy (8%) and numbness and tingling (5%). Patients treated in the ICU had a higher male presentation (73%). Several risk factors in terms of co-morbidities, were identified. Hypertension (54.5%), depression and anxiety (51%), sleep disorders in terms of insomnia and OSAS (30%), cardiovascular morbidity (28%), autoimmune diseases (25%), chronic lung diseases (24%) and diabetes mellitus type 2 (23%) founded as possible risk factors. Conclusion Neurological symptoms were found in the vast majority (74%) of the patients. Accordingly, attention to neurological, mental and sleep disturbances is warranted with involvement of neurological expertise, in order to avoid further complications and long-term neurological effect of COVID-19. Furthermore, risk factors for more severe COVID-19, in terms of possible co-morbidities that identified in this study should get appropriate attention to optimizing treatment strategies in COVID-19 patients

Unexpected Fat Distribution in Adolescents With Narcolepsy

Narcolepsy type 1 is a chronic sleep disorder with significantly higher BMI reported in more than 50% of adolescent patients, putting them at a higher risk for metabolic syndrome in adulthood. Although well-documented, the body fat distribution and mechanisms behind weight gain in narcolepsy are still not fully understood but may be related to the loss of orexin associated with the disease. Orexin has been linked to the regulation of brown adipose tissue (BAT), a metabolically active fat involved in energy homeostasis. Previous studies have used BMI and waist circumference to characterize adipose tissue increases in narcolepsy but none have investigated its specific distribution. Here, we examine adipose tissue distribution in 19 adolescent patients with narcolepsy type 1 and compare them to 17 of their healthy peers using full body magnetic resonance imaging (MRI). In line with previous findings we saw that the narcolepsy patients had more overall fat than the healthy controls, but contrary to our expectations there were no group differences in supraclavicular BAT, suggesting that orexin may have no effect at all on BAT, at least under thermoneutral conditions. Also, in line with previous reports, we observed that patients had more total abdominal adipose tissue (TAAT), however, we found that they had a lower ratio between visceral adipose tissue (VAT) and TAAT indicating a relative increase of subcutaneous abdominal adipose tissue (ASAT). This relationship between VAT and ASAT has been associated with a lower risk for metabolic disease. We conclude that while weight gain in adolescents with narcolepsy matches that of central obesity, the lower VAT ratio may suggest a lower risk of developing metabolic disease

Rapidly Progressive Toxic Leukoencephalomyelopathy with Myelodysplastic Syndrome: a Clinicopathological Correlation

Neurological disorders induced by long-term exposure to organic solvents typically have a slowly progressive clinical course, which may be arrested or even reversed following discontinuation of exposure. We report an unusual case of rapidly progressive toxic leukoencephalomyelopathy in a 29-year-old man who had worked at a chemical factory that used toluene for the manufacture of nylon 66 for 5 years. He presented with progressive weakness of legs, recurrent seizures, and cognitive decline. Widespread white-matter changes in the brain and spinal cord, and myelodysplastic syndrome were noted. He died 6 months after the onset of his symptoms, and autopsy showed discrete multifocal demyelination and necrosis in the central nervous system, and dysplastic cells of erythroid, myeloid, and megakaryotic lineages in blood vessels. The co-occurrence of leukoencephalomyelopathy and myelodysplastic syndrome highlights the vulnerability of the white matter and bone marrow to injury from organic solvents. Intravascular congestion of dysplastic hematopoietic cells might have led to his unusually rapid progression of leukoencephalomyelopathy

Основы самостоятельной профессионально-прикладной физической подготовки студентов медицинских вузов

ВГМУЛЕЧЕБНАЯ ФИЗКУЛЬТУРАФИЗИЧЕСКАЯ КУЛЬТУРА ЛЕЧЕБНАЯФИЗИЧЕСКАЯ ПОДГОТОВКАРассматриваются вопросы для самостоятельного изучения основ профессионально-прикладной физической подготовки будущих работников в сфере медицинского обслуживания населения

Система дистанційної освіти та її захист

BACKGROUND: It is currently unknown whether early immunomodulatory treatment in relapsing-remitting MS (RRMS) can delay the transition to secondary progression (SP). OBJECTIVE: To compare the time interval from onset to SP in patients with RRMS between a contemporary cohort, treated with first generation disease modifying drugs (DMDs), and a historical control cohort. METHODS: We included a cohort of contemporary RRMS patients treated with DMDs, obtained from the Swedish National MS Registry (disease onset between 1995-2004, n = 730) and a historical population-based incidence cohort (onset 1950-64, n = 186). We retrospectively analyzed the difference in time to SP, termed the "period effect" within a 12-year survival analysis, using Kaplan-Meier and Cox regression analysis. RESULTS: We found that the "period" affected the entire severity spectrum. After adjusting for onset features, which were weaker in the contemporary material, as well as the therapy initiation time, the DMD-treated patients still exhibited a longer time to SP than the controls (hazard ratios: men, 0.32; women, 0.53). CONCLUSION: Our results showed there was a longer time to SP in the contemporary subjects given DMD. Our analyses suggested that this effect was not solely driven by the inclusion of benign cases, and it was at least partly due to the long-term immunomodulating therapy given