Non-attendance rate in a Danish University Clinic of Dermatology.

AIM: To clarify the rate of non-attendance (NA) in an out-patient clinic. METHODS: Attendance lists of 3592 patients were collected daily from 21 July-21 August and 21 October-21 November, 2009. NA patients were contacted to determine extenuations. To study NA in relation to diagnosis and age, a control group of patients who attended before or after a NA was established. Furthermore, two time periods from 8:00-11:30 AM and 11:30 AM-3:00 pm were compared. RESULTS: In total, 13% NA gave no cancellation (54.2% females and 45.8% males). Divided into age groups, 496 patients 0-25 years old had appointments, but 87 (18.6%) showed NA. In the 26-65 years old, 2188 patients were planned, but 313 (14.1%) showed NA. Over 65 years old, 878 patients were planned, but 69 patients (7.9%) showed NA. NA was higher (P < 0.05) in patients 0-25 years old in comparison with the other age groups. Diagnoses had no influence on the rate of NA (P > 0.05), neither had seasons nor time of the day. The main explanations reported by the NA were: forgetfulness (34.3%), erroneous scheduling (27.7%) and various reasons (38.0%). However, 18.5% had shown NA before while 17.1% were NA first timers. CONCLUSION: The NA rate 13% of 3592 patients was mostly patient-related. Erroneous scheduling was estimated to be 3.6%. NA was more frequent among young patients. NA rate is small in comparison with non-adherence to medicines, however, of major practical and economic consequence for the health system. SMS or e-mail notification and improved scheduling are potential actions to improve NA in the routine.

Toxic hepatitis induced by infliximab in a patient with rheumatoid arthritis with no relapse after switching to etanercept.

We present a case of toxic hepatitis related to infliximab treatment in a 38-year-old woman with rheumatoid arthritis (RA). The patient had previously been treated with different disease-modifying drugs (DMARDs) alone or in combination but had never revealed signs of liver dysfunction. Due to high disease activity, treatment with infliximab (3 mg/kg i.v.) was initiated in combination with methotrexate (MTX) (25 mg/week) and folic acid (5 mg/week). The patient stopped MTX and folic acid on her own initiative after 3 weeks due to improvement of joint symptoms. After seven infusions, progressive elevations of the transaminases up to five times the upper normal limit were noted and treatment with infliximab was terminated. Serological tests for viral and autoimmune hepatitis and for ANA and anti-dsDNA were all negative. Specific infliximab antibodies could not be detected. Ultrasound of the liver was normal. Liver biopsy showed late signs of acute toxic hepatitis without MTX-related fibrosis. This is one the first cases that convincingly demonstrates that infliximab treatment may cause toxic hepatitis. Moreover, the case suggests a lack of hepatic cross-toxicity between infliximab and etanercept as the patient continued with etanercept without new episodes of liver dysfunction.

Estimation of serum concentration of parvovirus B19 DNA by PCR in patients with chronic anaemia.

Parvovirus B19 DNA was detected in serum samples from 10 out of 42 patients with chronic anaemia, the majority of whom suffered from aplastic anaemia, haemolytic anaemia, pure red cell anaemia or myelodysplastic syndrome. Nested PCR methods with sensitivities of 0.005-0.05 fg DNA were developed. In nine patients, B19 DNA could only be detected by nested PCR. Conventional PCR with a sensitivity of 50 fg B19 DNA could only detect B19 DNA in one patient. In the majority of B19-DNA-positive patients, the DNA concentration was estimated at 0.005-0.05 fg per 5 microliters serum.

[Parvovirus B19 infections. The cause of fifth disease-erythema infectiosum--can also cause aplastic crises, fetal damage and polyarthritis]. / Parvovirus B19 infektionen. Arsagen til den femte børnesygdom-erythema infectiosum--kan også føre til aplastiske kriser, fosterskader og polyarthritis.

Human parvovirus B19 can be an important etiological factor in aplastic crises in patients with chronic hemolytic anemia, in fetal damage, and in acute polyarthritis. B19-virus can only be grown in cell cultures established from human bone marrow, where the virus production occurs in erythroblasts. Parvovirus can cause severe, often fatal, infections in various kinds of animals, also in their fetuses, and many cases of teratogenic changes have been described. The B19-infection is diagnosed by demonstration of either IgM antibodies or B19-DNA in serum samples obtained in the early phases of infection. Patients with EI are infectious before skin eruptions occur, i.e. in the prodromal phase where virus can be detected in respiratory secretion. Transmission of the infection by concentrated, heat-treated factor preparations has been reported. Acute polyarthritis accompanying B19-infections has most often been described to affect the finger, hand and knee joints in adult women. Maternal B19-infections can be complicated by intrauterine infections damaging the fetus and resulting in abortion, hydrops fetalis or stillbirth. The B19-infection has not with certainty been found to be teratogenic. Recent studies seem to show that about 10-20% of primary maternal infections can be complicated by fetal damage, but until further this percentage should be regarded with great reservation.

[The fifth disease--erythema infectiosum. Parvovirus infection in a family group]. / Den femte børnesygdom--erythema infectiosum. Parvovirus-infektion i familiegruppen.

The causative agent of Erythema Infectiosum (EI), also known as the fifth disease, has been shown to be Human Parvovirus B19. This virus may also cause foetal damage, resulting in spontaneous abortion, hydrops foetalis or stillbirth. Three cases of Human Parvovirus infection in a family are presented. The child has a classical rash. The father had a rash and joint-symptoms, which is common in adults. The mother had a subclinical infection, which is seen in the majority of EI cases. As the woman was pregnant, ultrasonic tests were carried out frequently to detect possible hydrops foetalis. This pregnancy resulted in a healthy full term infant weighing 3,610 g.