The prevalence of atrial fibrillation in Greenland: a register-based cross-sectional study based on disease classifications and prescriptions of oral anticoagulants.

Previous studies of the prevalence of atrial fibrillation (AF) in Greenland are based on either single-point electrocardiograms (ECGs) or patients admitted with stroke. This study estimates the prevalence of AF based on disease classifications in the electronic medical record system (EMR) and prescriptions of oral anticoagulants (OACs). Patients given a diagnose classification code for AF or atrial flutter or prescribed the vitamin K antagonist Warfarin or the direct-acting oral anticoagulant Rivaroxaban were identified in the EMR. Descriptive data and selected laboratory values were extracted, and a minimum CHA2DS2-VASc score was calculated for the 790 patients identified in the EMR (66% men). A total prevalence of AF of 1.4% was found in the general population (1.8% among men and 1.0% among women), with a significantly lower prevalence among women younger than 70 years. There was a significant increase in AF-prevalence with advancing age (p<0.001) for both men and women. A minimum CHA2DS2-VASc was estimated and app. 10% of the patients may be undertreated with OACs. The prevalence of AF found in this study is higher than that found in previous studies in Greenland and comparable to the prevalence found in other Western countries, indicating that AF is common in Greenland.

Comparative cardiovascular physiology: future trends, opportunities and challenges.

The inaugural Kjell Johansen Lecture in the Zoophysiology Department of Aarhus University (Aarhus, Denmark) afforded the opportunity for a focused workshop comprising comparative cardiovascular physiologists to ponder some of the key unanswered questions in the field. Discussions were centred around three themes. The first considered function of the vertebrate heart in its various forms in extant vertebrates, with particular focus on the role of intracardiac shunts, the trabecular ('spongy') nature of the ventricle in many vertebrates, coronary blood supply and the building plan of the heart as revealed by molecular approaches. The second theme involved the key unanswered questions in the control of the cardiovascular system, emphasizing autonomic control, hypoxic vasoconstriction and developmental plasticity in cardiovascular control. The final theme involved poorly understood aspects of the interaction of the cardiovascular system with the lymphatic, renal and digestive systems. Having posed key questions around these three themes, it is increasingly clear that an abundance of new analytical tools and approaches will allow us to learn much about vertebrate cardiovascular systems in the coming years.

Autonomic control of cardiorespiratory interactions in fish, amphibians and reptiles

Control of the heart rate and cardiorespiratory interactions (CRI) is predominantly parasympathetic in all jawed vertebrates, with the sympathetic nervous system having some influence in tetrapods. Respiratory sinus arrhythmia (RSA) has been described as a solely mammalian phenomenon but respiration-related beat-to-beat control of the heart has been described in fish and reptiles. Though they are both important, the relative roles of feed-forward central control and peripheral reflexes in generating CRI vary between groups of fishes and probably between other vertebrates. CRI may relate to two locations for the vagal preganglionic neurons (VPN) and in particular cardiac VPN in the brainstem. This has been described in representatives from all vertebrate groups, though the proportion in each location is variable. Air-breathing fishes, amphibians and reptiles breathe discontinuously and the onset of a bout of breathing is characteristically accompanied by an immediate increase in heart rate plus, in the latter two groups, a left-right shunting of blood through the pulmonary circuit. Both the increase in heart rate and opening of a sphincter on the pulmonary artery are due to withdrawal of vagal tone. An increase in heart rate following a meal in snakes is related to withdrawal of vagal tone plus a non-adrenergic-non-cholinergic effect that may be due to humoral factors released by the gut. Histamine is one candidate for this role.

Digestive challenges for vertebrate animals: microbial diversity, cardiorespiratory coupling, and dietary specialization.

The digestive system is the interface between the supply of food for an animal and the demand for energy and nutrients to maintain the body, to grow, and to reproduce. Digestive systems are not morphologically static but rather dynamically respond to changes in the physical and chemical characteristics of the diet and the level of food intake. In this article, we discuss three themes that affect the ability of an animal to alter digestive function in relation to novel substrates and changing food supply: (1) the fermentative digestion in herbivores, (2) the integration of cardiopulmonary and digestive functions, and (3) the evolution of dietary specialization. Herbivores consume, digest, and detoxify complex diets by using a wide variety of enzymes expressed by bacteria, predominantly in the phyla Firmicutes and Bacteroidetes. Carnivores, such as snakes that feed intermittently, sometimes process very large meals that require compensatory adjustments in blood flow, acid secretion, and regulation of acid-base homeostasis. Snakes and birds that specialize in simple diets of prey or nectar retain their ability to digest a wider selection of prey. The digestive system continues to be of interest to comparative physiologists because of its plasticity, both phenotypic and evolutionary, and because of its widespread integration with other physiological systems, including thermoregulation, circulation, ventilation, homeostasis, immunity, and reproduction.

Autonomic control of cardiorespiratory interactions in fish, amphibians and reptiles.

Control of the heart rate and cardiorespiratory interactions (CRI) is predominantly parasympathetic in all jawed vertebrates, with the sympathetic nervous system having some influence in tetrapods. Respiratory sinus arrhythmia (RSA) has been described as a solely mammalian phenomenon but respiration-related beat-to-beat control of the heart has been described in fish and reptiles. Though they are both important, the relative roles of feed-forward central control and peripheral reflexes in generating CRI vary between groups of fishes and probably between other vertebrates. CRI may relate to two locations for the vagal preganglionic neurons (VPN) and in particular cardiac VPN in the brainstem. This has been described in representatives from all vertebrate groups, though the proportion in each location is variable. Air-breathing fishes, amphibians and reptiles breathe discontinuously and the onset of a bout of breathing is characteristically accompanied by an immediate increase in heart rate plus, in the latter two groups, a left-right shunting of blood through the pulmonary circuit. Both the increase in heart rate and opening of a sphincter on the pulmonary artery are due to withdrawal of vagal tone. An increase in heart rate following a meal in snakes is related to withdrawal of vagal tone plus a non-adrenergic-non-cholinergic effect that may be due to humoral factors released by the gut. Histamine is one candidate for this role.

Convalescence after inguinal herniorrhaphy.

BACKGROUND: Convalescence after inguinal herniorrhaphy is usually 3-4 weeks and is an important outcome parameter of hernia surgery. The aim of this study was to describe in detail the consequences of recommending a short convalescence, including the risk of recurrence. METHODS: This was a multicentre prospective questionnaire study in patients given a recommendation for short convalescence (1 day); information was recorded on expected length of convalescence, employment status, physical workload and limiting factors. The reoperation rate in patients included in the study (group 1, n = 1059) was compared with that for comparable patients treated in participating departments but not part of the study group (group 2, n = 1306) and patients in the Danish Hernia Database (group 3, n = 8297). RESULTS: The median time off work was 7 days and the time interval before carrying out the most strenuous leisure activity was 14 days. After 30 days, 6.8 per cent of patients had not resumed employment and 17.0 per cent had not yet resumed strenuous leisure activity. Important reasons for not resuming work and leisure activity were pain (approximately 60 per cent of patients) and wound problems (approximately 20 per cent). The reoperation rate in group 1 at the median observation time was 0.7 per cent, which was no different to that in group 2 (1.6 per cent) (P = 0.186) or group 3 (1.4 per cent) (P = 0.092). CONCLUSION: Reduced convalescence after inguinal herniorrhaphy may be recommended without incurring a risk of higher reoperation rates. Pain and wound problems remain the most important factors for not resuming work or leisure activity as recommended.

Interlocking nailing of humeral shaft fractures.

: In this retrospective study 48 humeral shaft fractures in 48 patients were operated on using the Seidel interlocking nail. The length of follow-up ranged from 6 to 60 months (median, 26 months). The treatment of fractures was satisfactory with the Seidel nail, but we emphasize the importance of countersinking the tip of the nail into the humeral head to avoid impingement. In 5 of 12 patients with non-unions, the procedure failed, and we found that the distal locking seemed to be inadequate. Pathological fractures (i.e., those caused by metastatic tumors) were all efficiently treated with the Seidel nail.

A formal system of approval for monographs in the pharmacopoeia of culture media--statement from the IUMS-ICFMH working party on culture media.

A categorization system for monographs on culture media is outlined which will lead to more rapid publication and a formal division into three classifications; draft, proposed and approved. This should assist the quality assurance and accreditation processes in food microbiology laboratories.

Lack of relationship between serum and gallbladder bile calcium in patients with gallstone disease.

BACKGROUND: Recent studies suggest that alternation in serum calcium influences the level of gallbladder bile ionized calcium (Ca2+). Theoretically, this could increase the risk of calcium precipitation in the gallbladder. METHODS: We therefore measured serum and gallbladder bile minerals in patients with gallstones (n = 27) and without (n = 10, controls). The serum samples were taken just prior to induction of anaesthesia and gallbladder bile was aspirated before any manipulation of the gallbladder. RESULTS: The active molality of Ca2+ in gallbladder bile was not statistically significant different between cases and controls (0.44 +/- 0.16 vs. 0.40 +/- 0.10 mmol/kg), whereas pH was significantly lower (6.94 +/- 0.31 vs. 7.36 +/- 0.28, p < 0.0001) and cholesterol higher (4.37 +/- 2.70 vs. 1.79 +/- 1.33 mmol/l; p < 0.01) in gallbladder bile obtained from cases. Serum Ca2+ at actual pH, magnesium and phosphate were significantly higher among cases than in controls. Gallbladder bile active molality of Ca2+ was significantly correlated with bile total calcium in both groups (r = 0.72; p < 0.001 and r = 0.91; p < 0.001, respectively). In controls only, we observed a positive relationship between serum Ca2+ at actual pH and the active molality of Ca2+ in bile (r = 0.61; p < 0.05). CONCLUSION: Our study demonstrates that Ca2+ in gallbladder bile does not differ between cases and controls. The lack of correlation between serum and gallbladder bile constituents in cases compared to controls suggests that changes in calcium equilibration between bile and serum in patients with gallstone disease might be of importance for the formation of gallstones.

Observer variation in the radiographic classification of fractures of the neck of the femur using Garden's system.

By means of Kappa statistics, we calculated the inter- and intra-observer variation in the classification of fractures of the neck of the femur according to Garden's system. Radiographs of 96 consecutive patients were assessed independently by six observers who agreed on classification for only 14 fractures (15%). The level of agreement was poor for the overall classification (Kappa = 0.39). When reducing Garden's system into non-displaced (Stage I and II) and displaced fractures (Stage III and IV) the level of agreement became acceptable (Kappa = 0.68). However, problems remain in distinguishing Stage II and Stage III fractures, and further improvements in the classification system are necessary.

The role of carbon dioxide and atmospheric air in double-contrast barium enema.

BACKGROUND: Patient discomfort 0-24 h after double-contrast barium enema (DCBE) was investigated in two ways. METHODS: In part 1, 139 patients, not previously informed, were contacted by telephone to assess symptom rates without bias. In part 2, designed as a prospective randomized double-blind trial, the effect of carbon dioxide (CO2) as an insufflating gas was compared with conventional atmospheric air (AA). RESULTS: Part 1: 10% experienced severe abdominal pain, and 18% severe abdominal distention. Part 2: Low discomfort rates were found for both severe pain (7% for AA vs. 2% for CO2) and severe distention (13% for AA vs. 8% for CO2); the differences were not significant. In both parts of the study, female patients with a history of abdominal discomfort of "colon irritable" type were significantly overrepresented in the severely symptomatic groups. Equal numbers of patients experiencing severe abdominal distention for the first time were found in both the AA and CO2 groups, ruling out AA as the sole cause of these symptoms. CONCLUSION: Abdominal post-DCBE discomfort seems to be less frequent than previously reported and is not effectively eliminated by CO2. We still find the use of AA in DCBEs justified.

[Salmonella dublin]. / Salmonella dublin.

Salmonella dublin's natural host is cattle; it may cause acute disease in calves, while adult animals may be asymptomatic carriers. In humans S. dublin is the most invasive of the zoonotic Salmonella-bacteria found in Denmark. It is much more frequently isolated from the blood than from the faeces and may give rise to serous metastatic infections in practically all organs. The number of registered human infections rose from zero to 46 per year during the period 1980-1988, but has now stabilized at a level of about 20 per year. Outbreaks have been described abroad as being caused by unpasteurised milk and cheese; in Denmark beef and cow's liver must be viewed as the dominant source of infection. The direct routes of infection are, however, unknown. Tightening of regulations for the slaughtering of animals from S. dublin infected herds, optimal hygiene in the slaughterhouses and increased cooperation between the veterinary and medical professions concerning investigation of routes of infection are necessary measures to be taken in order to reduce the number of human S. dublin infections.

Evaluation of a new semi-automated screening method for the detection of Salmonella in foods within 24 h.

A new method for the detection of Salmonella in foods and feeds, 'The EiaFoss Salmonella Method' has been performance tested in comparison with a traditional technique, the Rappaport-Vassiliadis cultural procedure, as reference method. The new method is based on a two step enrichment procedure (19 and 3 h) using two different pre-enrichment broths (Salmonella enrichment broth, SEB I and SEB II) for raw and processed foods, followed by an automated enzyme immunoassay (EIA) carried out in the 'EiaFoss analyser'. A total of 161 food and nine feed samples were investigated. Only naturally contaminated samples were used. Viable Salmonella were recovered in 30 samples using either method. When using the EiaFoss Salmonella Method 13% more samples (27:24) were proved salmonella-positive compared with the reference method. The explanation for the better performance of the EiaFoss Salmonella Method is discussed and attributed in part to better enrichment procedures when using SEB I or SEB II.

Application of multilocus enzyme electrophoresis in studies of the epidemiology of Listeria monocytogenes in Denmark.

A total of 245 strains of Listeria monocytogenes were investigated. These strains were isolated from human and animal cases of listeriosis as well as from different kinds of raw and processed foods. Thirty-three electrophoretic types (ETs) were identified among the 245 strains. The strains investigated included all human clinical strains isolated in Denmark during 1989 and 1990. Seventy-three percent of the strains isolated in this period were assigned to one of only two ETs (ET 1 and ET 4). ET 1, which was found to be the most frequently occurring ET among strains isolated from human clinical cases, was also found to occur rather frequently in animal clinical cases. ET 1 was, however, found only sporadically among strains isolated from foods and food factories. The data indicate that there might be something distinctive about the physiology or ecology of the ET 1 clone which makes it more likely to bring about disease in human beings either because of high pathogenicity or because of a special ability to multiply to infectious doses in processed foods. Another type, designated ET 4, was found to be the next most frequently occurring ET, after ET 1, among human clinical isolates. This could be explained by the fact that ET 4 was found to be the most frequently occurring ET within food isolates.

Microbiological aspects and technological need: technological needs for nitrates and nitrites.

Nitrate and nitrite are used in meat and fish curing, and in the manufacture of certain cheeses. Nitrate itself has little antimicrobial effect and in most applications could be replaced by lower concentrations of nitrite. Further, improved hygiene diminishes the need for nitrite. The antimicrobial activity and technological needs for nitrate and nitrite are reviewed. It is concluded that the technological needs for nitrite in meat products stored at < 10 degrees C could be met by added nitrite concentrations of 50 mg/kg. The overall effect of nitrate in salted fish appears to be marginal. In such products, Vibrio parahaemolyticus does not grow at salt concentrations of 10% and food poisoning by this organism is not related to the absence of nitrate or nitrite; growth of Clostridium botulinum Type E (the predominant cause of botulism from fish products) is arrested by salt concentrations of 3-4%. Listeria monocytogenes in seafood cannot be controlled by nitrite. The use of nitrate in cheese production could be avoided, or at least reduced to a low level by avoiding silage with a high count of gas-producing Clostridia and hygienic milk collection.

Percutaneous transluminal angioplasty in 226 iliac artery stenoses: role of the superficial femoral artery for clinical success.

We reviewed the results of 174 consecutive percutaneous transluminal angioplasties (PTA) for 226 iliac artery stenoses (mean length 1.6 cm, range 0.2-9.6 cm) in 150 patients with lower limb ischaemia. Vascular intervention was indicated by intermittent claudication in 123 and critical ischaemia in 51 (29%) limbs. There were 12 (7%) failed guide-wire recanalizations. Four (2%) serious complications from puncture site haemorrhages or peripheral embolizations were handed surgically and caused one major amputation. Five-year patency in 162 successful dilatations was 68% primarily and 81% secondary to vascular surgical reconstructions during an average 28 (range 1-60) months of observation. One hundred and thirteen (70%) limbs improved clinically. In 95 limbs treated exclusively by iliac PTA, clinical improvement was achieved in 38/47 (81%) limbs with patency and 24/48 (50%) limbs with occlusion of the superficial femoral artery (SFA) (p < 0.003), whereas vascular patency of iliac PTA was unaffected by status of the SFA. Five-year limb salvage rate was 50% in limbs with critical ischaemia. We conclude that PTA for iliac artery stenoses is a low-risk procedure offering acceptable clinical results provided the SFA is patent. As an adjunct to distal bypass surgery, iliac PTA improves inflow without the requirement for major aorto-iliac surgery and may extend indications for vascular intervention in patients with lower limb ischaemia.

Evaluation of an ELISA Test for Detection of Listeria spp.

An ELISA test and two routine culture procedures have been compared in their ability to detect Listeria spp. in food products and swabs of pig tonsils. The culture procedures used were those recommended by the Food and Drug Administration (FDA) and United States Department of Agriculture (USDA). One hundred samples of minced beef, artificially inoculated with Listeria monocytogenes , together with 149 naturally contaminated samples of minced beef, pig tonsil, pig feed and soft, whitemolded, blue-veined cheese were tested by the three methods. The USDA procedure proved to be the most sensitive detection method when samples of artificially contaminated meat containing less than 3 colony forming units (CFU) of L. monocytogenes per gram were examined. In samples where the L. monocytogenes count was above 3 CFU per gram, the ELISA test and the USDA-detection procedure proved to be equally sensitive. When naturally contaminated samples were examined, the sensitivity of the ELISA test was 92% and the specificity 80%. The detection limit of the ELISA test for demonstration of L. monocytogenes in pure cultures was found to be approximately 106 CFU per ml. The corresponding detection limit of the culture procedure was calculated to be approximately 104 CFU per ml.