Clinical presentation in EMS patients with acute chest pain in relation to sex, age and medical history: prospective cohort study.

OBJECTIVE: To assess symptom presentation related to age, sex and previous medical history in patients with chest pain. DESIGN: Prospective observational cohort study. SETTING: Two-centre study in a Swedish county emergency medical service (EMS) organisation. PARTICIPANTS: Unselected inclusion of 2917 patients with chest pain cared for by the EMS during 2018. DATA ANALYSIS: Multivariate analysis on the association between symptom characteristics, patients' sex, age, previous acute coronary syndrome (ACS) or diabetes and the final outcome of acute myocardial infarction (AMI). RESULTS: Symptomology in patients assessed by the EMS due to acute chest pain varied with sex and age and also with previous ACS or diabetes. Women suffered more often from nausea (OR 1.6) and pain in throat (OR 2.1) or back (OR 2.1). Their pain was more often affected by palpation (1.7) or movement (OR 1.4). Older patients more often described pain onset while sleeping (OR 1.5) and that the onset of symptoms was slow, over hours rather than minutes (OR 1.4). They were less likely to report pain in other parts of their body than their chest (OR 1.4). They were to a lesser extent clammy (OR 0.6) or nauseous (OR 0.6). These differences were present regardless of whether the symptoms were caused by AMI or not. CONCLUSIONS: A number of aspects of the symptom of chest pain appear to differ in unselected prehospital patients with chest pain in relation to age, sex and medical history, regardless of whether the chest pain was caused by a myocardial infarction or not. This complicates the possibility in prehospital care of using symptoms to predict the underlying aetiology of acute chest pain.

Prednisolone in Dogs-Plasma Exposure and White Blood Cell Response.

Glucocorticoids such as prednisolone are commonly used in dogs but there is sparse quantitative pharmacokinetic and pharmacodynamic information of this drug in this species. The objective of this study was to quantitatively characterize the concentration-effect relationship for prednisolone in dogs on neutrophil and lymphocyte trafficking and cortisol suppression. Nine beagles, 2-12 years old and part of a group for teaching/research were used in a 4-way crossover experiment including two treatments, active or placebo, administered either per os (PO) or intravenously (IV). Plasma was analyzed for prednisolone and cortisol using ultra-high performance liquid chromatography - tandem mass spectrometry. Leucocyte counts were performed in whole blood. Data was then analyzed by non-linear mixed effect modeling to estimate pharmacokinetic and pharmacodynamic parameters. After administration of prednisolone sodium succinate IV, the typical value (between subject variation) for total body prednisolone clearance was 1,370 ml/h·kg (13.4%). The volumes of the central and peripheral compartment were 2,300 ml/kg (10.7%) and 600 ml/kg (16.0%), respectively. The terminal plasma half-life was 1.7 h. The prednisolone plasma concentration producing 50% of the maximum response was 10 ng/mL (90.3%), 22.5 ng/ml (52.3%) and 0.04 ng/mL (197.3%) for neutrophil, lymphocyte and cortisol response, respectively. The administered dose (1 mg/kg) increased neutrophil and decreased lymphocyte numbers but not over the entire dosage interval of 24 h, due to the short half-life. However, glucocorticoids have a wide range of responses. An anti-inflammatory response due to altered gene transcription might have a longer duration. Future studies on the anti-inflammatory potency together with data presented are needed to optimize future dosage recommendations in dogs.

Effect of infrared and red monochromatic light on equine wound healing.

BACKGROUND: Light-emitting diodes (LEDs) are commonly used for treating a variety of disorders in horses, including wounds. Despite its claim to shorten healing times, there is a lack of scientific documentation regarding its effects. OBJECTIVES: To investigate if treatment with pulsating visible red light (λ ≈ 637 nm) and near-infrared (NIR) light (λ ≈ 956 nm) affects wound healing. STUDY DESIGN: Randomised blinded controlled experimental study. METHODS: A circular skin wound (Ø = 2 cm) was created on each side of the neck in eight healthy horses. One randomly chosen wound received light treatment and the other served as an untreated control. Treatment duration was 4 minutes and 40 seconds (red light 95 seconds, 2.3 mW/cm2 ; NIR light 185 seconds, 6.4 mW/cm2 ) and was performed once daily on day 0-4, 7-11, 14-18 and 21-25. The wounds were photographed and evaluated using digital photoplanimetry on day 0, 1, 2, 3, 4, 7, 14, 21, 28 and 35. The degree of swelling was assessed with diagnostic ultrasound on the same days except the last recording was performed on day 36 instead of 35. Days to total healing was recorded. ANOVA was used for statistical analysis (P < .05). RESULTS: The wound area (P = .2-.9) and degree of swelling (P = .2-1.0) did not differ between treated and control groups on any day. There was a significant difference (P = .03) in healing time between control (49.0, 95% CI = 35.4-62.6 days) and treated wounds (51.8, 95% CI = 38.7-64.8 days). MAIN LIMITATIONS: The wounds were treated until day 25 and this study does not investigate the effect of a longer treatment period than 25 days. CONCLUSIONS: The results of this study do not indicate any clinically relevant positive effect of pulsating visible red light and NIR light on the healing of experimental skin wounds in horses, compared with no treatment.

Hepatozoon canis infection causing a strong monocytosis with intra-monocytic gamonts and leading to erroneous leukocyte determinations.

In this case report, a Swedish flat-coated retriever was diagnosed with an extensive Hepatozoon canis infection. The dog had a prominent monocytosis (14.0 × 109 /L) with H canis gamonts detected in most monocytes, but none were found in the neutrophils. On the hematology system ADVIA 2120 peroxidase (PEROX) cytogram, most leukocytes were seen as a distinct cell population above the lymphocytes, which indicated that most of the cells were larger than lymphocytes and had weak myeloperoxidase staining. This distinct cell cluster appeared to be of a single cell type but was incorrectly divided by the ADVIA 2120 into lymphocytes, monocytes, and large unstained cells (LUC). The total leukocyte counts on the ADVIA 2120 WBC basophil (BASO) channel were much higher than that on the WBC PEROX count. The WBC BASO cytogram appeared abnormal with two parallel cell populations, so the BASO WBC count was considered erroneous. Polymerase chain reaction and DNA sequencing verified H canis infection. The dog was treated with subcutaneous imidocarb dipropionate (6 mg/kg) injections every other week. Post-treatment hematology analyses indicated that the percentage of parasitized leukocytes decreased from 40% to 5% about 4 weeks after the start of treatment and were not found in any monocytes 6 weeks after the beginning of the treatment. In conclusion, H canis infection in this dog was associated with a strong monocytosis, and gamonts were present in many monocytes, which caused aberrant automated leukocyte counts to occur.

Can financial insecurity and condescending treatment explain the higher prevalence of poor self-rated health in women than in men? A population-based cross-sectional study in Sweden.

INTRODUCTION: Women have in general poorer self-rated health than men. Both material and psychosocial conditions have been found to be associated with self-rated health. We investigated whether two such factors, financial insecurity and condescending treatment, could explain the difference in self-rated health between women and men. METHODS: The association between the two factors and self-rated health was investigated in a population-based sample of 35,018 respondents. The data were obtained using a postal survey questionnaire sent to a random sample of men and women aged 18-75 years in 2008. The area covers 55 municipalities in central Sweden and the overall response rate was 59%. Multinomial odds ratios for poor self-rated health were calculated adjusting for age, educational level and longstanding illness and in the final model also for financial insecurity and condescending treatment. RESULTS: The prevalence of poor self-rated health was 7.4% among women and 6.0% among men. Women reported more often financial insecurity and condescending treatment than men did. The odds ratio for poor self-rated health in relation to good self-rated health was 1.29 (95% CI: 1.17-1.42) for women compared to men when adjusted for age, educational level and longstanding illness. The association became, however, statistically non-significant when adjusted for financial insecurity and condescending treatment. CONCLUSION: The present findings suggest that women would have as good self-rated health as men if they had similar financial security as men and were not treated in a condescending manner to a larger extent than men. Longitudinal studies are, however, required to confirm this conclusion.

H. pylori seropositivity before age 40 and subsequent risk of stomach cancer: a glimpse of the true relationship?

Stomach carcinogenesis involves mucosal and luminal changes that favor spontaneous disappearance of Helicobacter pylori. Therefore, the association between the infection and cancer risk might typically be underestimated. As acquisition of the infection almost invariably occurs before adulthood, the serostatus at age 16-40 should best reflect the lifetime occurrence of the infection. We therefore conducted a case-control study nested within a historic cohort of about 400,000 individuals who donated sera before age 40 to either of two large Swedish Biobanks between 1968 and 2006, and whose records were linked to complete nationwide registers. For each stomach adenocarcinoma case occurring at least 5 years after serum donation 2 controls were selected matched on age, sex and year of donation and biobank. Serum immunoglobulin G antibodies against H. pylori cell-surface antigens (Hp-CSAs) were measured with an enzyme-linked immunosorbent assay and antibodies against CagA with an immunoblot assay. Conditional logistic regression models were used to estimate odds ratios (ORs) for stomach adenocarcinoma among H. pylori infected relative to uninfected. We confirmed 59 incident cases of stomach adenocarcinoma (41 non-cardia tumors) during follow-up. ORs for non-cardia stomach adenocarcinoma among subjects with Hp-CSA antibodies (regardless of CagA serostatus), antibodies against CagA (regardless of Hp-CSA serostatus), and antibodies to both, relative to those who were seronegative to both, were 17.1 (95% confidence interval [CI] 4.0-72.9), 10.9 (95% CI 3.2-36.9), and 48.5 (95% CI 5.8-407.4), respectively. H. pylori infection is a much stronger risk factor for non-cardia stomach adenocarcinoma than initially realized. However, further studies are needed to answer whether it is a necessary cause, as the possibility of misclassification of H. pylori status could not be ruled out in our study.

Molecular and clinical characteristics of invasive group A streptococcal infection in Sweden.

BACKGROUND: The incidence and severity of invasive group A streptococcal infection demonstrate great variability over time, which at least, in part, seems to be related to group A streptococcal type distribution among the human population. METHODS: An enhanced surveillance study of invasive group A streptococcal infection (746 isolates) was performed in Sweden from April 2002 through December 2004. Noninvasive isolates from either the throat or skin (773 isolates) were collected in parallel for comparison. Clinical and epidemiological data were obtained from 88% of patients with invasive disease and were related to isolate characteristics, including T type, emm sequence type, and the presence of 9 superantigen genes, as well as pulsed-field gel electrophoresis pattern comparisons of selected isolates. RESULTS: The annual incidence was 3.0 cases per 100,000 population. Among the patients with invasive disease, 11% developed streptococcal toxic shock syndrome, and 9.5% developed necrotizing fasciitis. The overall case-fatality rate was 14.5%, and 39% of the patients with streptococcal toxic shock syndrome died (P<.001). The T3/13/B3264 cluster accounted for 33% of invasive and 25% of noninvasive isolates. Among this most prevalent type cluster, emm types 89 and 81 dominated. Combined results from pulsed-field gel electrophoresis, emm typing, and superantigen gene profiling identified subgroups within specific emm types that are significantly more prone to cause invasive disease than were other isolates of the same type. CONCLUSIONS: This study revealed a changing epidemiology of invasive group A streptococcal infection in Sweden, with emergence of new emm types that were previously not described. The results also suggest that some clones may be particularly prone to cause invasive disease.