Differential diagnostics of polymyalgia rheumatica in a university hospital in Finland.

OBJECTIVES: Diagnosing polymyalgia rheumatica (PMR) can be difficult as many conditions present with similar symptoms and findings. This study aimed to analyse how often the diagnosis of PMR changes during follow-up in a university hospital setting and to determine the most common clinical conditions initially misdiagnosed as PMR. METHOD: All patients with a new primary diagnosis of PMR on at least one visit during the years 2016-2019 were identified from the hospital discharge register of Turku University Hospital, Finland. A diagnosis of PMR was confirmed if the patient met at least one of the five classification criteria, complete clinical follow-up (median 34 months) was compatible with PMR, and no other diagnosis better explained their condition. RESULTS: Of the patients initially diagnosed with PMR, 65.5% were considered to have PMR after further evaluation and clinical follow-up. The most common conditions initially diagnosed as PMR were inflammatory arthritides (34.9%), degenerative or stress-related musculoskeletal disorders (13.2%), infection (9.3%), malignancy (9.3%), giant cell vasculitis (6.2%) and other vasculitis (6.2%), and a wide range of other less common diseases. The diagnosis of PMR remained in 81.3% of patients who fulfilled the 2012 American College of Rheumatology/European League Against Rheumatism PMR classification criteria and in 45.5% of patients who did not. CONCLUSIONS: Diagnosing PMR is challenging, even in a university hospital. One-third of the initial diagnoses of PMR changed during further evaluation and follow-up. There is a substantial risk of misdiagnosis, especially in patients with atypical presentation, and the differential diagnoses of PMR must be considered carefully.

Bleeding complications in cholecystectomy: a register study of over 22,000 cholecystectomies in Finland.

BACKGROUND: Major bleeding is rare but among the most serious complications of laparoscopic surgery. Still very little is known on bleeding complications and related blood component use in laparoscopic cholecystectomy (LC). The aim of this study is to compare bleeding complications, transfusion rates and related costs between LC and open cholecystectomy (OC). METHODS: Data concerning LCs and OCs and related blood component use between 2002 and 2007 were collected from existing computerized medical records (Finnish Red Cross Register) of ten Finnish hospital districts. RESULTS: Register data included 17175 LCs and 4942 OCs. In the LC group, 1.3% of the patients received red blood cell (RBC) transfusion compared to 13% of the patients in the OC group (p < 0.001). Similarly, the proportions of patients with platelet (0.1% vs. 1.2%, p < 0.001) and fresh frozen plasma (FFP) products (0.5% vs. 5.8%) transfusions were respectively higher in the OC group than in the LC group. The mean transfused dose of RBCs, PTLs and FFP product Octaplas or the mean cost of the transfused blood components did not differ significantly between the LC and OC groups. CONCLUSIONS: Laparoscopic cholecystectomy was associated with lower transfusion rates of blood components compared to open surgery. The severity of bleeding complications may not differ substantially between LC and OC.

Laboratory-based surveillance of COVID-19 in the Greater Helsinki area, Finland, February-June 2020.

OBJECTIVES: The aim was to characterise age- and sex-specific severe acute respiratory syndrome coronavirus disease-2 (SARS-CoV-2) RT-PCR sampling frequency and positivity rate in Greater Helsinki area in Finland during February-June 2020. We also describe the laboratory capacity building for these diagnostics. METHODS: Laboratory registry data for altogether 80,791 specimens from 70,517 individuals was analysed. The data included the date of sampling, sex, age and the SARS-CoV-2 RT-PCR test result on specimens collected between 1 February and 15 June 2020. RESULTS: Altogether, 4057/80,791 (5.0%) of the specimens were positive and 3915/70,517 (5.6%) of the individuals were found positive. In all, 37% of specimens were from male and 67% from female subjects. While the number of positive cases was similar in male and female subjects, the positivity rate was significantly higher in male subjects: 7.5% of male and 4.4% of female subjects tested positive. The highest incidence/100,000 was observed in those aged ≥80 years. The proportion of young adults in positive cases increased in late May 2020. Large dips in testing frequency were observed during every weekend and also during public holidays. CONCLUSIONS: Our data suggest that men pursue SARS-CoV-2 testing less frequently than women. Consequently, a subset of coronavirus disease-2019 infections in men may have gone undetected. People sought testing less frequently on weekends and public holidays, and this may also lead to missing of positive cases. The proportion of young adults in positive cases increased towards the end of the study period, which may suggest their returning back to social behaviour with an increased risk of infection.

Declining cholecystectomy rate during the era of statin use in Finland: a population-based cohort study between 1995 and 2009.

BACKGROUND AND AIMS: Aging with comorbidities, obesity, and rapid recovery from operation may increase the need for laparoscopic cholecystectomy, but long-term use of statins may be associated with a decreased risk of gallstones. This population-based cohort study presents the changing rate and causative factors of laparoscopic cholecystectomy in Finland during the era of statin use. MATERIALS AND METHODS: Age structure of the population, changes in body mass index and diabetes, and the number of all cholecystectomies in 1995-2009 were retrieved from the registers of National Institute for Health and Welfare. Additionally, these results were supplemented by a population-based retrospective cohort (1581 laparoscopic cholecystectomy) in one community-based hospital area. The risk factors for laparoscopic cholecystectomy, use of statins, and surgical outcome were analyzed. RESULTS: During the 15 years, 123,794 cholecystectomies were performed in Finland, of which 94,740 (76.5%) were performed using laparoscopic technique. The median rate of laparoscopic cholecystectomy varied between 110 and 140 operations per 100,000 inhabitants. In 1995-2009, the annual number of cholecystectomies decreased from 8600 to 7500, the number of laparoscopic cholecystectomies increased by 10%, and the number of open cholecystectomies declined by 60%. In a cohort of 1581 laparoscopic cholecystectomies, the proportion of elderly (>65 years of age), obese (body mass index > 30 kg/m(2)), and diabetic patients increased from 17% to 28%, 9% to 34%, and 4% to 8%, respectively. Use of statins increased more than fourfold during the 15 years. CONCLUSIONS: The rates of all cholecystectomies decreased despite marked increase in laparoscopic cholecystectomies performed. The increase in risk factors for gallstones in Finland implied more marked increase in laparoscopic cholecystectomies. The possible role of statins on gallstone disease is discussed.