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  • Helanterä, I.; Janes, R.; Anttila, V-J (2018)
    Background: Influenza A(H1N1) causes serious complications in immunocompromised patients. The efficacy of seasonal vaccination in these patients has been questioned. Aim: To describe two outbreaks of influenza A(H1N1) in immunocompromised patients. Methods: Two outbreaks of influenza A(H1N1) occurred in our institution: on the kidney transplant ward in 2014 including patients early after kidney or simultaneous pancreas-kidney transplantation, and on the oncology ward in 2016 including patients receiving chemotherapy for malignant tumours. Factors leading to these outbreaks and the clinical efficacy of seasonal influenza vaccination were analysed. Findings: Altogether 86 patients were exposed to influenza A(H1N1) during the outbreaks, among whom the seasonal influenza vaccination status was unknown in 10. Only three out of 38 vaccinated patients were infected with influenza A(H1N1), compared with 20 out of 38 unvaccinated patients (P = 0.02). The death of one out of 38 vaccinated patients was associated with influenza, compared with seven out of 38 unvaccinated patients (P = 0.06). Shared factors behind the two outbreaks included outdated facilities not designed for the treatment of immunosuppressed patients. Vaccination coverage among patients was low, between 40% and 70% despite vaccination being offered to all patients free of charge. Vaccination coverage of healthcare workers on the transplant ward was low (46%), but, despite high coverage on the oncology ward (92%), the outbreak occurred. Conclusion: Seasonal influenza vaccination was clinically effective with both a reduced risk of influenza infection and a trend towards reduced mortality in these immunocompromised patients. Several possible causes were identified behind these two outbreaks, requiring continuous awareness in healthcare professionals to prevent further outbreaks. (C) 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
  • Satopaa, Jarno; Mustanoja, Satu; Meretoja, Atte; Putaala, Jukka; Kaste, Markku; Niemela, Mika; Tatlisumak, Turgut; Strbian, Daniel (2017)
    Background and aims: We evaluated the accuracy of 19 published prognostic scores to find the best tool for predicting mortality after intracerebral hemorrhage (ICH). Methods: A retrospective single-center analysis of consecutive patients with ICH (n = 1013). After excluding patients with missing data (n = 131), we analyzed 882 patients for 3-month (primary outcome), in-hospital, and 12-month mortality. We analyzed the strength of the individual score components and calculated the c-statistics, Youden index, sensitivity, specificity, negative and positive predictive value (NPV and PPV) for the scores. Finally, we included every score component in a multivariable model to analyze the maximum predictive value of the data elements combined. Results: Observed in-hospital mortality was 23.6%, 3-month mortality was 31.0%, and 12-month mortality was 35.3%. For in-hospital mortality, the National Institutes of Health Stroke Scale (NIHSS) performed equally good as the best score for the other outcomes, the ICH Functional Outcome Score (ICH-FOS). The c-statistics of the scores varied from 0.6293 (95% CI 0.587-0.672) to 0.8802 (0.855-0.906). With all variables from all the scores in a multivariable regression model, the c-statistics did not improve, being 0.89 (0.867-0.913). Using the Youden index cutoff for the ICH-FOS score, the sensitivity (73%), specificity (90%), PPV (76%), and NPV (88%) for the primary outcome were good. Conclusions: A plethora of scores exists to help clinicians estimate the prognosis of an acute ICH patient. The NIHSS can be used to quantify the risk of in-hospital death while the ICH-FOS performed best for the other outcomes. (C) 2017 Elsevier B.V. All rights reserved.
  • Panduru, Nicolae Mircea; Nistor, Ionut; Groop, Per-Henrik; Van Biesen, Wim; Farrington, Ken; Covic, Adrian (2017)
    The increasing prevalence of chronic kidney disease (CKD) and diabetes over the last decade has resulted in increasing numbers of frail older patients with a combination of these conditions. Current treatment guidelines may not necessarily be relevant for such patients, who are mostly excluded from the trials upon which these recommendations are based. There is a paucity of data upon which to base the management of older patients with CKD. Nearly all current guidelines recommend less-tight glycaemic control for the older population, citing the lack of proven medium-term benefits and concerns about the high short-term risk of hypoglycaemia. However, reports from large landmark trials have shown potential benefits for both microvascular and macrovascular complications, though the relevance of these findings to this specific population is uncertain. The trials have also highlighted potential alternative explanations for the hazards of intensive glycaemic control. These include depression, low endogenous insulin reserve, low body mass index and side effects of the medication. Over the last few years, newer classes of hypoglycaemic drugs with a lower risk of hypoglycaemia have emerged. This article aims to present a balanced view of advantages and disadvantages of intense glycaemic control in this group of patients, which we hope will help the clinician and patient to come to an individualized management approach.
  • Barrouin-Melo, Stella Maria; Anturaniemi (o.s. Roine), Johanna; Sankari, Satu; Griinari, Mikko; Atroshi, Faik; Ounjaijean, Sakaewan; Hielm-Bjorkman, Anna Katrina (2016)
    Background: Oxidative stress plays an important role in the pathogenesis of disease, and the antioxidant physiological effect of omega-3 from fish oil may lead to improvement of canine spontaneous osteoarthritis (OA). Methods: In this prospective randomized, controlled, double-blinded study, we assessed haematological and biochemical parameters in dogs with OA following supplementation with either a concentrated omega-3 deep sea fish oil product or corn oil. Blood samples from 77 client-owned dogs diagnosed as having OA were taken before (baseline) and 16 weeks after having orally ingested 0.2 ml/Kg bodyweight/day of deep sea fish oil or corn oil. Circulating malondialdehyde (MDA), glutathione (GSH), non-transferrin bound iron (NTBI), free carnitine (Free-Car), 8-hydroxy-2-deoxyguanosine (8-OH-dG), and serum fatty acids, haemograms and serum biochemistry were evaluated. Differences within and between groups from baseline to end, were analysed using repeated samples T-test or Wilcoxon rank test and independent samples T-test or a Mann-Whitney test. Results: Supplementation with fish oil resulted in a significant reduction from day 0 to day 112 in MDA (from 3.41 +/- 1.34 to 2.43 +/- 0.92 mu mol/L; P <0.001) and an elevation in Free-Car (from 18.18 +/- 9.78 to 21.19 +/- 9.58 mu mol/L; P = 0.004) concentrations, whereas dogs receiving corn oil presented a reduction in MDA (from 3.41 +/- 1.34 to 2.41 +/- 1.01 mu mol/L; P = 0.001) and NTBI (from -1.25 +/- 2.17 to -2.31 +/- 1.64 mu mol/L; P = 0.002). Both groups showed increased (albeit not significantly) GSH and 8-OH-dG blood values. Dogs supplemented with fish oil had a significant reduction in the proportions of monocytes (from 3.84 +/- 2.50 to 1.77 +/- 1.92 %; P = 0.030) and basophils (from 1.47 +/- 1.22 to 0.62 +/- 0.62 %; P = 0.012), whereas a significant reduction in platelets counts (from 316.13 +/- 93.83 to 288.41 +/- 101.68 x 10(9)/L; P = 0.029), and an elevation in glucose (from 5.18 +/- 0.37 to 5.32 +/- 0.47 mmol/L; P = 0.041) and cholesterol (from 7.13 +/- 1.62 to 7.73 +/- 2.03 mmol/L; P = 0.011) measurements were observed in dogs receiving corn oil. Conclusions: In canine OA, supplementation with deep sea fish oil improved diverse markers of oxidative status in the dogs studied. As corn oil also contributed to the reduction in certain oxidative markers, albeit to a lesser degree, there was no clear difference between the two oil groups. No clinical, haematological or biochemical evidence of side effects emerged related to supplementation of either oil. Although a shift in blood fatty acid values was apparent due to the type of nutraceutical product given to the dogs, corn oil seems not to be a good placebo.
  • Jayanti, Anuradha; Neuvonen, Markus; Wearden, Alison; Morris, Julie; Foden, Philip; Brenchley, Paul; Mitra, Sandip; BASIC-HHD Study Grp (2015)
    Background: Medical decision-making is critical to patient survival and well-being. Patients with end stage renal disease (ESRD) are faced with incrementally complex decision-making throughout their treatment journey. The extent to which patients seek involvement in the decision-making process and factors which influence these in ESRD need to be understood. Methods: 535 ESRD patients were enrolled into the cross-sectional study arm and 30 patients who started dialysis were prospectively evaluated. Patients were enrolled into 3 groups-'predialysis' (group A), 'in-centre' haemodialysis (HD) (group B) and self-care HD (93 % at home-group C) from across five tertiary UK renal centres. The Autonomy Preference Index (API) has been employed to study patient preferences for information-seeking (IS) and decision-making (DM). Demographic, psychosocial and neuropsychometric assessments are considered for analyses. Results: 458 complete responses were available. API items have high internal consistency in the study population (Cronbach's alpha > 0.70). Overall and across individual study groups, the scores for information-seeking and decision-making are significantly different indicating that although patients had a strong preference to be well informed, they were more neutral in their preference to participate in DM (p <0.05). In the age, education and study group adjusted multiple linear regression analysis, lower age, female gender, marital status; higher API IS scores and white ethnicity background were significant predictors of preference for decision-making. DM scores were subdivided into tertiles to identify variables associated with high (DM > 70: and low DM ( Conclusion: ESRD patients prefer to receive information, but this does not always imply active involvement in decision-making. By understanding modifiable and non-modifiable factors which affect patient preferences for involvement in healthcare decision-making, health professionals may acknowledge the need to accommodate individual patient preferences to the extent determined by the individual patient factors.
  • Jokihaara, Jarkko; Porsti, Ilkka H.; Sievanen, Harri; Koobi, Peeter; Kannus, Pekka; Niemela, Onni; Turner, Russell T.; Iwaniec, Urszula T.; Järvinen, Teppo L. N. (2016)
    Introduction Phosphate binding with sevelamer can ameliorate detrimental histomorphometric changes of bone in chronic renal insufficiency (CRI). Here we explored the effects of sevelamer-HCl treatment on bone strength and structure in experimental CRI. Methods Forty-eight 8-week-old rats were assigned to surgical 5/6 nephrectomy (CRI) or renal decapsulation (Sham). After 14 weeks of disease progression, the rats were allocated to untreated and sevelamer-treated (3% in chow) groups for 9 weeks. Then the animals were sacrificed, plasma samples collected, and femora excised for structural analysis (biomechanical testing, quantitative computed tomography). Results Sevelamer-HCl significantly reduced blood pH, and final creatinine clearance in the CRI groups ranged 30%-50% of that in the Sham group. Final plasma phosphate increased 2.4- to 2.9-fold, and parathyroid hormone 13- to 21-fold in CRI rats, with no difference between sevelamer-treated and untreated animals. In the femoral midshaft, CRI reduced cortical bone mineral density (-3%) and breaking load (-15%) (p Conclusions In this model of stage 3-4 CRI, sevelamer-HCl treatment ameliorated the decreases in femoral midshaft and neck mineral density, and restored bone strength despite prevailing acidosis. Therefore, treatment with sevelamer can efficiently preserve mechanical competence of bone in CRI.
  • Helve, Jaakko; Haapio, Mikko; Groop, Per-Henrik; Finne, Patrik (2021)
    Background Comorbidities are associated with increased mortality among patients receiving long-term kidney replacement therapy (KRT). However, it is not known whether primary kidney disease modifies the effect of comorbidities on KRT patients' survival. Methods An incident cohort of all patients (n = 8696) entering chronic KRT in Finland in 2000-2017 was followed until death or end of 2017. All data were obtained from the Finnish Registry for Kidney Diseases. Information on comorbidities (coronary artery disease, peripheral vascular disease, left ventricular hypertrophy, heart failure, cerebrovascular disease, malignancy, obesity, underweight, and hypertension) was collected at the start of KRT. The main outcome measure was relative risk of death according to comorbidities analyzed in six groups of primary kidney disease: type 2 diabetes, type 1 diabetes, glomerulonephritis (GN), polycystic kidney disease (PKD), nephrosclerosis, and other or unknown diagnoses. Kaplan-Meier estimates and Cox regression were used for survival analyses. Results In the multivariable model, heart failure increased the risk of death threefold among PKD and GN patients, whereas in patients with other kidney diagnoses the increased risk was less than twofold. Obesity was associated with worse survival only among GN patients. Presence of three or more comorbidities increased the age- and sex-adjusted relative risk of death 4.5-fold in GN and PKD patients, but the increase was only 2.5-fold in patients in other diagnosis groups. Conclusions Primary kidney disease should be considered when assessing the effect of comorbidities on survival of KRT patients as it varies significantly according to type of primary kidney disease.