Validity of reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden.

AIM: To describe differences and similarities between reported and non-reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden. METHODS: Prospective and retrospective data for treated OHCA patients in Sweden, 2008-2010, were compared in the Swedish Cardiac Arrest Register. Data were investigated in three Swedish counties, which represented one third of the population. The recording models varied. Prospective data are those reported by the emergency medical service (EMS) crews, while retrospective data are those missed by the EMS crews but discovered afterwards by cross-checking with the local ambulance register. RESULT: In 2008-2010, the number of prospectively (n=2398) and retrospectively (n=800) reported OHCA cases was n=3198, which indicates a 25% missing rate. When comparing the two groups, the mean age was higher in patients who were reported retrospectively (69 years vs. 67 years; p=0.003). There was no difference between groups with regard to gender, time of day and year of OHCA, witnessed status or initial rhythm. Bystander cardiopulmonary resuscitation (CPR) was more frequent among patients who were reported prospectively (65% vs. 60%; p=0.023), whereas survival to one month was higher among patients who were reported retrospectively (9.2% vs. 11.9%; p=0.035). CONCLUSION: Among 3198 cases of OHCA in three counties in Sweden, 800 (25%) were not reported prospectively by the EMS crews but were discovered retrospectively as missing cases. Patients who were reported retrospectively differed from prospectively reported cases by being older, having less frequently received bystander CPR but having a higher survival rate. Our data suggest that reports on OHCA from national quality registers which are based on prospectively recorded data may be influenced by selection bias.

Inactivation of promoter 1B of APC causes partial gene silencing: evidence for a significant role of the promoter in regulation and causative of familial adenomatous polyposis.

Familial adenomatous polyposis (FAP) is caused by germline mutations in the adenomatous polyposis coli (APC) gene. Two promoters, 1A and 1B, have been recognized in APC, and 1B is thought to have a minor role in the regulation of the gene. We have identified a novel deletion encompassing half of this promoter in the largest family (Family 1) of the Swedish Polyposis Registry. The mutation leads to an imbalance in allele-specific expression of APC, and transcription from promoter 1B was highly impaired in both normal colorectal mucosa and blood from mutation carriers. To establish the significance of promoter 1B in normal colorectal mucosa (from controls), expression levels of specific transcripts from each of the promoters, 1A and 1B, were examined, and the expression from 1B was significantly higher compared with 1A. Significant amounts of transcripts generated from promoter 1B were also determined in a panel of 20 various normal tissues examined. In FAP-related tumors, the APC germline mutation is proposed to dictate the second hit. Mutations leaving two or three out of seven 20-amino-acid repeats in the central domain of APC intact seem to be required for tumorigenesis. We examined adenomas from mutation carriers in Family 1 for second hits in the entire gene without any findings, however, loss of the residual expression of the deleterious allele was observed. Three major conclusions of significant importance in relation to the function of APC can be drawn from this study; (i) germline inactivation of promoter 1B is disease causing in FAP; (ii) expression of transcripts from promoter 1B is generated at considerable higher levels compared with 1A, demonstrating a hitherto unknown importance of 1B; (iii) adenoma formation in FAP, caused by impaired function of promoter 1B, does not require homozygous inactivation of APC allowing for alternative genetic models as basis for adenoma formation.

Education in cardiopulmonary resuscitation in Sweden and its clinical consequences.

AIM: To describe the use of cardiopulmonary resuscitation (CPR) training programmes in Sweden for 25 years and relate those to changes in the percentage of patients with out of hospital cardiac arrest (OHCA) who receive bystander CPR. METHODS: Information was gathered from (a) the Swedish CPR training registry established in 1983 and includes most Swedish education programmes in CPR and (b) the Swedish Cardiac Arrest Register (SCAR) established in 1990 and currently covers about 70% of ambulance districts in Sweden. RESULTS: CPR education in Sweden functions according to a cascade principle (instructor-trainers who train instructors who then train rescuers in CPR). Since 1989, 5000 instructor-trainers have taught more than 50,000 instructors who have taught nearly 2 million of Sweden's 9 million inhabitants adult CPR. This is equivalent to one new rescuer per 100 inhabitants every year in Sweden. In addition, since 1989, there are 51,000 new rescuers in Advanced Life Support (ALS), since 1996, 41,000 new Basic Life Support (BLS) rescuers with Automated External Defibrillation (AED) training, and since 1998, there are 93,000 new rescuers in child CPR. As a result of this CPR training the number of bystander CPR attempts for OHCA in Sweden increased from 31% in 1992 to 55% in 2007. CONCLUSION: By using a cascade principle for CPR education nearly 2 million rescuers were educated in Sweden (9 million inhabitants) between 1989 and 2007. This resulted in a marked increase in bystander CPR attempts.

Transferrin C subtypes and occupational photodermatosis of the face.

In a factory in northern Sweden where 120 workers were uniformly exposed to photoactive substances 73 developed occupational facial eczema while 47 showed no reaction. The workers were examined with respect to 16 genetic marker systems: HLA, blood groups (ABO, Rh, MNSs, P, K, Le and Fy) and serum groups (Hp, Tf, Gc, Pi, Bf, C3, C4 and C6). Between reactors and nonreactors the following differences were found: (1) a significant decrease (p less than 0.05) of HLA A11 among the reactors; (2) a significant increase (p less than 0.05) of the C3 FS type among the reactors; (3) a highly significant increase (p less than 0.001) of the transferrin C2 gene and of the C2 variant among the reactors. The association with Tf C2 remained significant also after correction for number of significance tests. Since transferrin (iron) is known to catalyze the formation of hydroxyl radicals we hypothesize that the Tf C2 variant is more efficient in promoting radical formation and thereby cell damage. Other results supporting the notion that transferrin C2 may be associated with an increased susceptibility to toxic damage are discussed.

Oral lichen planus and contact allergy to mercury.

29 patients with oral lichen planus and amalgam fillings were patch tested for contact allergy to dental materials. 18 of these patients (62%) had a contact allergy to mercury. In a control material, the frequency of mercury allergy was 3.2%. In 3 of the patients the lesions healed completely after removal of the amalgam fillings. On the basis of these findings it is recommended that all amalgam fillings be removed after a positive patch test to mercury, as a step in the treatment of oral lichen planus.

Lack of association between allergic contact dermatitis and HLA antigens of the A and B series.

A previous study of patients with allergic contact dermatitis yielded results which supported the hypothesis that the presence of certain HLA antigens led to a predisposition to allergen-specific reactions and others to multiple contact sensitivity. The present study was performed to test this hypothesis. 129 patients sensitive to one allergen only (either chromium, nickel, formalin or balsam of Peru) and 83 patients sensitive to two or more allergens were HLA typed regarding the A and B loci. A series of 368 persons matched with regard to sex, age and place of residence were used as controls. A tendency towards an association between HLA B7 and contact allergy was observed. No other data confirming the hypothesis mentioned above were obtained. Among 37 patients who also had atopic diathesis a decreased frequency of HLA B7 was found.

Clinical evaluation in acne.

Various methods for clinical evaluation of the effect of treatment of acne vulgaris have been studied. Counting of acne lesions was found to be more sensitive than the opinion of the patients and the assessment of colour photographs. The correlation between the results obtained by lesion counts and evaluation by photographs was low, as was also the reproducibility of photographic assessment. This methodological study was performed during a 6 week period, using a double-blind technique for comparing the effect of 0.6 g of oral zinc sulphate daily versus placebo in 54 patients. With zinc treatment acne improved with about one third as rated with a score system. Compared to placebo this result is slightly better (p less than 0.05). Inflammatory acne of grades 2-3 responded more favourably than comedonal acne to zinc treatment.

Ispagula powder: an allergen in the work environment.

Bulk laxatives based on ispagula powder have given no known allergic side effects when administered perorally. Twenty-seven out of 64 workers in a pharmaceutical factory developed rhinitis, conjunctivitis or asthma when engaged in the packing of ispagula husks, an operation which gives rise to dust. The symptoms are accounted for by a type 1 allergy acquired from ispagula husks. This allergy can be demonstrated by intracutaneous and provocation tests. Occupational health measures were taken which reduced the dust content to a minimum; thereafter only one new case of sensitization was recorded during the next 24 months of observation. Five similar cases were reported among nursing staff exposed to the dust of ispagula while administering doses of bulk laxative.

Allergic contact dermatitis from chromate in military textiles.

Two cases with allergic contact dermatitis from chromate in green military uniform sweater and pants are described. Chemical analysis showed that water-soluble chromate was released from a uniform even after repeated washings.

Oral zinc in acne vulgaris: a clinical and methodological study.

In a double-blind investigation of 54 patients suffering from acne vulgaris, the effect of 0.6 g of oral zinc sulphate daily versus placebo was studied. During the active treatment period of 6 weeks, the acne improved by about one-third, as rated with a score system. Clinical comparison with placebo showed the result of zinc sulphate therapy to be slightly, but statistically significantly better. Various methods for the clinical evaluation of acne were studied. Counting of acne lesions was found to be a more precise method than assessment according to the opinion of the patients and the assessment of colour photographs. The correlation between the results obtained by lesion counting and evaluation by photographs was low, as was also the reproducibility of photographic assessment.

HLA antigens in allergic contact dermatitis.

The relationship between HLA factors and allergic contact dermatitis was examined in a series of 149 patients with unequivocal positive reactions to one or several allergens on epicutaneous testing. Nine statistically significant associations involving 6 different HLA antigens and 6 different allergens were found. Four allergens (chromium, formalin, balsam of Peru and wool alcohol) were positively associated with the B7 antigen. Furthermore chromium allergy was associated with A3, formalin allergy with A2 (negative association) and A9, nickel allergy with B8 and colophony allergy with B27. The B7 antigen and the combination A3+B7 showed significant regressions on number of allergies. The results fit the hypothesis that some HLA factors (like B7) may predispose for multiple contact allergy and others for allergen specific reactions.