Microthrombotic renal involvement in an SLE patient with concomitant catastrophic antiphospholipid syndrome: the beneficial effect of rituximab treatment.

Antiphospholipid syndrome is characterized by multiple arterial and/or venous thrombotic events, recurrent fetal losses in the presence of antiphospholipid antibodies (aPL). Catastrophic antiphospholipid syndrome is a life-threatening, rare subset of antiphospholipid syndrome when the thrombotic events affect at least three organs, and clinical manifestations develop simultaneously or within a week. Diagnostically, small vessel occlusions can be detected by histopathology in the presence of aPL. Our case report describes an 18-year-old man who has been treated for antiphospholipid syndrome associated with systemic lupus erythematosus (SLE) since 2011. The clinical findings were dominated by recurrent deep vein thrombosis, and severe proteinuria caused by lupus nephritis, accompanied by mild serological and laboratory findings. The patient was hospitalized in March 2014 because of severe thrombocytopenia and infective diarrhoea. At this time the renal functions deteriorated rapidly. Simultaneously, left upper extremity paresis was observed; computed tomography showed ischaemic lesions in the territory of the middle cerebral artery. Abdominal discomfort and pain occurred. On computed tomography scan ischaemic lesions were seen in the spleen, the right kidney and the coeliac trunk. Laboratory and serological findings verified the presence of aPL and anti-DNA antibodies, anaemia and thrombocytopenia. Based on the above-mentioned clinical and laboratory findings, the diagnosis of catastrophic antiphospholipid syndrome was established. Anticoagulation, corticosteroids and plasma exchange treatment, as well as haemodiafiltration were initiated. Although the thrombotic cascade decelerated following these interventions, we could not see an improvement in the renal function. Rituximab treatment was started, leading to a significant improvement in renal function. After 5 weeks of treatment the patient was discharged from hospital.

A scanning drift tube apparatus for spatiotemporal mapping of electron swarms.

A "scanning" drift tube apparatus, capable of mapping of the spatiotemporal evolution of electron swarms, developing between two plane electrodes under the effect of a homogeneous electric field, is presented. The electron swarms are initiated by photoelectron pulses and the temporal distributions of the electron flux are recorded while the electrode gap length (at a fixed electric field strength) is varied. Operation of the system is tested and verified with argon gas; the measured data are used for the evaluation of the electron bulk drift velocity. The experimental results for the space-time maps of the electron swarms - presented here for the first time - also allow clear observation of deviations from hydrodynamic transport. The swarm maps are also reproduced by particle simulations.

Leaf litter decomposition in Torna stream before and after a red mud disaster.

The aim of the study was to estimate the breakdown of the allochthonous litter in an artificial stream running in an agricultural area and compare it with the same values following a toxic mud spill into the same stream. Litter bags were filled with three types of leaves (Quercus robur, Populus tremula and Salix alba) and placed to the bottom of the river. Ergosterol was used to detect fungal biomass. We supposed the absence of fungi and the retardation of leaf litter decomposition. Only pH and conductivity increased significantly. Leaf mass loss after the catastrophe was much slower than in 2009 and the decay curves did not follow the exponential decay model. Prior to the catastrophe, leaf mass loss was fast in Torna, compared to other streams in the area. The reason is that the stream is modified, the bed is trapezoid and covered with concrete stones. Fungal biomass was lower, than in the pre-disaster experiment, because fungi did not have enough leaves to sporulate. Leaf mass loss followed the exponential decay curve before the disaster, but after that it was possible only after a non-change period.

Preventive home visits to older home-dwelling people in Denmark: are invitational procedures of importance?

Since 1998 all municipalities in Denmark have been required by law to offer two annual preventive home visits to all home-dwelling citizens aged 75 or over. The influence of invitational procedures on acceptance rates has not been investigated. The aim of this study was to describe and investigate whether different invitational procedures were associated with first preventive home visit acceptance rates. The study was based on secondary analyses of data from the Danish Intervention Study on Preventive Home Visits. Data were collected from 1998 to 2002. Of the 4060 participants in the main study, 3245 reported receiving an offer for an identifiable preventive home visit, of whom 2399 (73.9%) provided complete data for the main analyses in the present study. Invitational procedures were categorised as: (1) a letter with a proposed date and time for the visit, (2) a visitor telephone call, and (3) a letter with encouragement to phone the visitor for appointment (letter without a proposed date). Covariates included sex, age, experience with preventive interventions, functional ability, self rated health, social relations and psychosocial characteristics. Statistical analyses included chi-square tests, and bi- and multivariable logistic regression analyses. Different invitational procedures were associated with first preventive home visit acceptance rates. Significantly more men (75.1%) than women (62.8%) declined the first preventive home visit regardless of the invitational procedure. Compared to 'letter with a proposed date', men had an odds ratio of 1.78 (95% CI: 1.16-2.74) for declining visits when 'telephone call' was used and an odds ratio 2.81 (95% CI: 1.79-4.40) when 'letter without a proposed date' was used as the invitational procedure. In women the odds ratios were 1.23 (95% CI: 0.91-1.68) and 1.87 (95% CI: 1.37-2.55), respectively.

In-house validation of liquid chromatography tandem mass spectrometry for determination of semicarbazide in eggs and stability of analyte in matrix.

An improved LC-MS/MS method for the determination of semicarbazide in whole egg is described. Waters OASIS-MCX cation exchange purification cartridges increased the sensitivity for analysis by LC-MS/MS. The validation study was carried out according to criteria and requirements of Commission Decision 2002/657/EC for confirmatory analysis and provided the data as follows: The correlation coefficient for the matrix calibration curve, in the range of 0-5 microg kg(-1), was r=0.9968. The detection capability and decision limit, measured according to ISO11843-2, were CCalpha=0.20 microg kg(-1) and CCbeta=0.25 microg kg(-1). Repeatability (CVSr) and within-laboratory reproducibility (CVSwr) determined for the concentration levels of 0.2, 0.5 and 1.0 microg kg(-1) SEM ranged from 11.9 to 5.7% and 11.8 to 6.3%, respectively. The validated method was applied to investigate SEM stability in incurred materials (egg homogenates) during long-term storage at -20 degrees C and 4 degrees C. The study proved by a two-sampling test that SEM at levels of 17. 7, 1.2, 10.6 and 0.47 microg kg(-1) was stable for up to 12 months.

A feasible model for prevention of functional decline in older home-dwelling people--the GP role. A municipality-randomized intervention trial.

BACKGROUND: Danish municipalities are required by state law to offer two annual home visits to all non-disabled citizens > or =75 years. Visits are primarily carried out by district nurses. GPs are rarely directly involved. OBJECTIVE: To evaluate the effects of offering an educational programme to home visitors and GPs on mortality, functional ability and nursing home admissions among home-dwelling older people. DESIGN: Municipality pair-matched randomized trial. SETTING: Danish primary care. SUBJECT: 2863 home-dwelling 75-year-olds and 1171 home-dwelling 80-year-olds living in 34 municipalities. INTERVENTION: Home visitors received regular education for a period of 3 years. In nine of 17 intervention municipalities, GPs participated in one small group training session during the first year. MAIN OUTCOME MEASURES: Mortality, functional ability and nursing home admission during 4(1/2) years of follow-up. RESULTS: INTERVENTION was not associated with mortality. Home visitor education was associated with reduction in functional decline among home-dwelling 80-year-olds after the three intervention years in municipalities where GPs accepted and participated in small group-based training. Effects did not persist after the intervention ended. When analyses were restricted to baseline non-disabled persons, intervention was associated with beneficial effects on functional ability after three intervention years among 80-year-olds, regardless of education was given to home visitors alone or to visitors and GPs. Nursing home admission rates were lower among the 80-year-olds living in the intervention municipalities. CONCLUSION: A brief, practicable interdisciplinary educational programme for primary care professionals postponed functional decline in non-disabled 80-year-old home-dwelling persons.

ELISA for semicarbazide and its application for screening in food contamination.

The development of a direct competitive enzyme-linked immunosorbent assay (ELISA) based on polyclonal antibodies specific for semicarbazide (SEM) is described. Molecular modelling of the hapten mimics and other key components of the assay system was conducted to explain antibody properties in relation to hapten design. The small aliphatic molecule SEM was coupled to 3-carboxybenzaldehyde to produce carboxyphenyl-SEM (CPSEM), for the generation of specific antibodies. Five rabbits produced antibodies against NPSEM (used in direct and indirect ELISA formats) exhibiting a 50% binding inhibition level (IC(50) values) of 0.06-2.28 microgL(-1) in assay buffer for SEM. The most sensitive indirect assay based on the antibody MVK39 showed a high dynamic range providing a linear readout in the range of 0.01-0.2 microgL(-1). Antibody MVK31 (IgG) allowed specific SEM detection at an IC(50)=0.14 microgL(-1) in direct ELISA and was evaluated using solvent extracted SEM-spiked porcine and baby food samples. Recovery levels determined from fortified samples (0.5, 1.0, 1.5, 5, 10 and 20 microgkg(-1)) of porcine and baby food ranged from 82.9 to 105.3%, respectively, with a coefficient of variation less than 15.5%. Respective detection capability and threshold of the assay for porcine muscle, set on the basis of acceptance of no false negative results, was 0.3 and 0.11 microgkg(-1).

Preventive home visits to home-dwelling older people and hospital admissions: a municipality-randomised intervention trial.

Preventive home visits to older home-dwelling people have been part of national policy in Denmark since 1996. The aim was to evaluate whether education of home visitors and GPs was associated with hospital admission rates. In a population-based prospective controlled intervention trial in 34 municipalities, intervention municipality visitors received regular education during 3 years and GPs were introduced to a short assessment programme. Participation totalled 4,034 75- and 80-year-old home-dwelling persons, of which 3,132 (78%) had no mobility disability at baseline. Complete data on hospital services were obtained for all participants. No difference was observed in time to first admission between older people living in the intervention municipalities compared with people living in the control municipalities, HR 0.93 (95%CI: 0.85, 1.02, P = 0.17). Duration of first hospital stay was the same in the two groups (7.3 days). The mean number of admissions was not associated with intervention. Accepting and receiving home visits was associated with a reduced risk of hospital admission, HR 0.84 (95%CI: 0.76, 0.92), especially among the initially disabled. Hospital admission rates were associated with functional decline patterns. Persons experiencing catastrophic and progressive decline had the highest risk. Persons experiencing reversible functional decline were more often hospitalised in the intervention municipalities, and fewer persons living in the intervention municipalities experienced progressive decline. Education of primary care professionals was not associated with risk for first hospital admission among all older people living in the community, but may be associated with older people's different functional decline patterns.

Preventive home visits to older people in Denmark--why, how, by whom, and when?

In Denmark, political decisions improved the implementation of 'preventative thinking' into every-day clinical work. The potential benefits of preventive efforts have been supported by legislative and administrative incentives, and an ongoing effort to remain focused on the benefits of these initiatives towards older people is politically formulated and underlined as part of the new structured municipality reform. Evidence of beneficial effects of health promotion and prevention of disease in old age is well documented. In-home visits with individualised assessments make it possible to reach older persons not normally seen in the health care system. In-home assessment is not just a health check, but also an opportunity to meet individual needs that may be of importance for older people to stay independent. Preventive home visits may be part of an overall culture and strategy to avoid or prevent functional decline. There is an urgent need of an interdisciplinary teamwork and management for such programmes, incorporating flexible cooperation between the primary and secondary health care sector. The value and importance of geriatric and gerontological education is evidence based.

Educational intervention toward preventive home visitors reduced functional decline in community-living older women.

OBJECTIVE: To investigate whether immediate effects of a 3-year educational intervention in primary health care were confirmed 18 months after the end of the intervention. STUDY DESIGN AND SETTING: A controlled 3-year intervention study in 34 Danish municipalities with randomization and intervention at municipality level. The 17 intervention municipality visitors received regular education, and GPs were introduced to a short assessment program. The effect was measured at the individual level by questions about functional ability at the end of the intervention period and 1(1/2) years later; 4,060 older adults living in the municipalities participated. We adopt the approach introduced by Dufouil et al. (2004) and treat dropouts due to death differently from dropouts from other reasons. RESULTS: Educational intervention to primary care professionals was associated with better functional ability in surviving women at the end of the intervention (odds ratio [OR]: 1.24, 95% confidence interval [CI]=1.07-1.45), from the end of the intervention until 1(1/2) years later (OR: 1.21, 95% CI=1.03-1.44) and during the total study period (OR: 1.22, 95% CI=1.06-1.42). No effects were seen in men. CONCLUSION: The effect of a brief, feasible educational intervention for primary care professionals is sustained in women 1(1/2) years after the end of the intervention.

Preventive home visits to older home-dwelling people and different functional decline patterns.

A preventive home visitation scheme has been part of Danish legislation since 1996. The aim of this study was to describe functional trajectories of older home-dwelling people, and to identify whether education of the preventive home visitation staff and individual risk factors were related to specific functional decline patterns. The study is a secondary analysis of a population-based prospective controlled cohort study. Participation totalled 3,129 non-disabled 75- and 80-year-old men and women without mobility disability at baseline living in 34 municipalities. Self-reported functional ability was measured at baseline and after 1½, 3 and 4½ years follow-up. No functional decline was seen in 58% of the participants. A total of 17% developed catastrophic decline, 6% progressive and 7% showed a reversible decline pattern. The remaining 12% showed mixed patterns. Education of the preventive home visitation staff was associated with a reduced risk of progressive decline, RR = 0.66 (CI 95% 0.50-0.86, p = 0.002). Not receiving home visits and living alone were associated with increased risk of catastrophic decline. Younger age (75 at baseline) was less associated with all decline patterns compared with older age (80 at baseline). Men had less risk of developing progressive, reversible and mixed decline patterns than women, but an increased risk of developing catastrophic decline. A feasible educational preventive staff intervention was associated with a reduced risk of progressive functional decline but not with other functional decline patterns. Early signs of functional decline may serve as an important trigger for when to intensify the search for and actively seek to ameliorate preventable conditions.

Education of preventive home visitors: the effects on change in tiredness in daily activities.

The objective was to investigate whether a 3-year educational intervention towards primary health care professionals had effect on change in tiredness in daily activities during a 3-year intervention period in non-disabled older adults. The design was a controlled 3-year intervention study in 34 Danish municipalities with randomization and intervention at municipality level. The 17 intervention municipality visitors received regular education and general practitioners were introduced to a short assessment program. The effect was measured among old non-disabled individuals living in the municipalities by a validated scale on tiredness in daily activities at baseline and at the end of the intervention period. In total 2,515, 75- and 80-year-old men and women participated in all parts of the present study. Eighty-year-old non-disabled men and women who lived in the control municipalities had larger odds ratios of sustained tiredness during the 3-year intervention period compared with 80-year-olds living in intervention municipalities where both GPs and home visitors participated in the educational programme (OR = 3.48; 95% CI 1.51-8.00) and in intervention municipalities where only the home visitors (OR = 2.63; 95% CI 0.97-7.12) were educated. The intervention had no effect on stability and change in tiredness among the 75-year-old men and women. A brief, feasible educational intervention for primary care professionals has beneficial effect on changes in feelings of tiredness in non-disabled 80-year-old men and women.

Polypharmacy and older people--the GP perspective.

It is well known that problems with compliance rise exponentially when more that 4 drugs are prescribed. The rising use of prescription medicine forces the GP to balance the benefit of evidence group-based appropriate drug use against the problems arising when medication is given to older people and to consider different approaches when evaluating evidence of risk and benefit for the individual. Old people are facing a considerable risk of adverse drug reactions and recent initiatives, including the Continuous Medical Educational Efforts Programme, address issues of inappropriate prescribing practices. The authors recommend and present tools enabling the GP to focus on 'the core prescribing situation'. The logistics to optimise medication including compliance, the use of modern IT and better collaboration and communication between primary and secondary care are in focus. Since medication review is recommended at every encounter, and time consuming comprehensive follow-up will be demanded, 'polypharmacy consultations' surely will be built into GP contracts in the future. The authors state that a number of pharmacological regimens for older people are outperformed by non-pharmacological treatment alternatives involving competent individualised counselling and public provision of easy (transportation) possibilities for joining centres offering staff and equipment for physical and social activity (including basal aids for hearing and sight).

Preventive home visits to elderly people in Denmark.

During the last 20 years several randomised controlled trials have been published about preventive home visits to old people, but the benefit of the visits is still controversial and under debate. Based on a state law from the Ministry of Social Affairs in 1998, the municipalities in Denmark are obliged to offer home visits twice a year to all citizens 75 years and older. After six years with this law, there is still variation of how the law is managed and implemented. About 60% of the elderly people accept and receive the visits. Less than 50% of the municipalities have made specific guidelines and quality assurance indicators. More than the half have systematically used the visits to collect information of community needs and older people' wishes to be used for administrative and political purposes. In a prospective, controlled, feasibility study conducted over a 3-year period we found that a brief, manageable and ongoing educational intervention towards professionals working with preventive home visits is feasible and improves older people's functional mobility.

Medication for older people--aspects of rational therapy from the general practitioner's point of view.

This paper discusses GP perspectives on the principles underlying rational pharmacotherapy for older people. The rising use of prescription medicine forces the GP to balance the benefit of evidence group-based appropriate drug use against the problems arising when medication is given to older people and to consider different approaches when evaluating evidence of risk and benefit for the individual. Old people are facing a considerable risk of adverse drug reactions and recent initiatives, including the Continuous Medical Educational Efforts Programme, address issues of inappropriate prescribing practices. The authors recommend and present tools enabling the GP to focus on 'the core prescribing situation'. The logistics to optimise medication including compliance, the use of modern IT and better collaboration and communication between primary and secondary care are discussed. The authors state that a number of pharmacological regimens for older people are outperformed by non-pharmacological treatment alternatives involving competent individualised counselling and public provision of easy (transportation) possibilities for joining centres offering staff and equipment for physical and social activity (including basal aids for hearing and sight).

Contamination of animal feed and food from animal origin with mineral oil hydrocarbons.

Oils and fats used for the production of animal feed can become contaminated with mineral oil material originating from gas oils (C18-C35) or synthetic oils (poly-alpha olefins, C25 to beyond C45). An important cause is assumed to be the discharge of waste oils, such as motor oil and hydraulic oils. Mineral oil material was analysed by on-line LC-GC-FID directly in the fat or in a raw extract from animal feed or foodstuffs. In Switzerland in summer/autumn 1999 concentrations in oils and fats for feed production were often found to be between 100 and 1000 mg/kg. In the feeds, the average concentration was around 100 mg/kg with values ranging up to a maximum of 1000 mg/kg; few samples were free of contamination. In animal body fat, the average concentration determined in summer 1999 was 25 mg/kg, with a maximum of 150 mg/kg, although in samples from December 1999, contamination was substantially lower. In the fat phase of eggs, the average concentration was 30 mg/kg, with a maximum of 80 mg/kg. Paraffin oil is used for feed production, which may account for part of the contamination problem (e.g. eggs).

[Rehabilitation of anoxic brain injured patients after reanimation]. / Az anoxiás agykárosodást szenvedett betegek rehabilitációja reanimáció után.

Authors report rehabilitation outcomes of anoxic brain injured patients, following reanimation. In the past 12 years (1988-1999) they treated 54 patients. The patients were selected from other hospitals after successful reanimation, but sustained diffuse anoxic brain injury. The CT and MR examination was generally negative, but small hypodensities were shown rarely (18/54). At the time of admission 21 patients were quadriparetic, 5 patients were hemiparetic, 2 were paraparetic and there were no any paresis in 26 cases. The mean age of the patients was 32 years (7-61). At the time of admission 31 patients were dependent in basic activities of daily living, the mean Barthel Index score was 15 (0-100) but at the time of discharge it was 45 (0-100). 41 patients were discharged into their home and 13 patients had to be transmitted to another hospital for further treating, but later 5 of them died. At the time of discharge only 7 patients had score 100 of the Barthel Index, but they were not able for independent living. Family support, mainly guidance was necessary. Memory deficits, apraxia, attention disturbance, ataxia were the main problems during the rehabilitation process.

[Is the new LAE 355 certificate useful for extended sick leave benefits?]. / Er den udvidede attest LAE 355 anvendelig ved langvarige sygedagpengesager?

In Storstrøm county an investigation was carried out concerning certificates in connection with sickness benefit during a period of two months, and the general practitioners and the social-workers were asked about their opinion of and attitude to sickness-certificates. A total of 420 sickness benefit certificates were collected consecutively, and all the social-workers and 85% of the general practitioners participated. About half of the certificates were not completely filled out and only one fifth supplied constructive supplementary information. Forty-five percent of the social-workers and 33% of the general practitioners regarded the certificates as useless when dealing with social medical cases. A systematic followup of patients with long-term sickness is an important task in primary health care, and should be carried out in co-operation with other health- and social-workers.