Pregnancy and post-partum tuberculosis; a nationwide register-based case-control study, Denmark, 1990 to 2018.

BackgroundPregnancy increases the risk of tuberculosis (TB), however, data on TB epidemiology in pregnant women are limited.AimTo guide possible interventions, we analysed risk factors for TB in pregnant and post-partum women.MethodsWe conducted a nationwide retrospective register-based case-control study from January 1990 to December 2018 in Denmark. Cases were women diagnosed with TB during their pregnancy or in the post-partum period. We selected two control groups: pregnant or post-partum women without TB, and non-pregnant women with TB. Differences were assessed by chi-squared or Fisher's exact test. Risk factors for TB were identified through logistic regression and estimated by odds ratio (OR).ResultsWe identified 392 cases, including 286 pregnant and 106 post-partum women. Most were migrants (n = 366; 93%) with a shorter median time spent in Denmark (2.74 years; interquartile range (IQR): 1.52-4.64) than non-pregnant TB controls (3.98 years; IQR: 1.43-8.51). Cases less likely had a Charlson comorbidity index ≥ 2compared with non-pregnant TB controls (p < 0.0001), and had no increased risk of severe disease (p = 0.847). Migrants from other World Health Organization regions than Europe, especially Africa (OR: 187; 95%CI: 125-281) had persistently higher odds of TB.ConclusionsIn Denmark, the risk of TB in pregnant and post-partum women is increased in migrant women who have stayed in the country a median time of approximately 3 years. We recommend increased focus on TB risk during pregnancy and suggest evaluating targeted TB screening of selected at-risk pregnant women to promote early case finding and prevent TB among mothers and their newborn children.

[Diagnosis and treatment of acute colonic pseudo-obstruction]. / Diagnostik og behandling af akut colonpseudoobstruktion.

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie's syndrome, is a clinical condition with acute dilatation of the colon without a provable mechanical cause. Early recognition and treatment of the condition is important in order to improve the outcome. The diagnosis is based on clinical and radiographic findings. Supportive therapy should be the initial management. If no improvement occurs after 24 hours, medical treatment with neostigmine administered i.v. is instituted and repeated if necessary. Colonoscopic decompression is the next step, but if ischaemia or perforation appear surgery should be performed.

A comparison of three methods to evaluate maximum bladder capacity: cystometry, uroflowmetry and a 24-h voiding diary in women with urinary incontinence.

BACKGROUND: Maximum bladder capacity (MBC) is an important parameter in the evaluation of lower urinary tract function. Yet, there is no consensus on how to measure MBC. The aim of this study was to compare estimates of the maximum bladder capacity (MBC) using cystometry, uroflowmetry, and a 24-h voiding diary in women with urinary incontinence. METHODS: From 1 January 1998 to 31 December 1998 a retrospective review comprising 60 incontinent women in whom cystometry, uroflowmetry, and a 24-h voiding diary were performed were evaluated. RESULTS: Median age was 55 years (range: 34-90 years). In women with detrusor instability (DI), MBC was significantly higher when measured using a voiding diary (median: 400 ml) as compared with cystometry (median: 215 ml) (p = 0.017). A 'Bland-Altman plot' demonstrated poor agreement between MBC in women with DI measured using a voiding diary and cystometry, respectively. The cystometric MBC was significantly higher in women with a stable detrusor (373 ml) as compared with women with DI (215 ml) (p = 0.0027). However, in women with or without DI there were no differences between MBC measured either using a voiding diary (400 vs. 360 mL) or by uroflowmetry (260 vs. 254 ml), respectively. CONCLUSIONS: A low cystometric MBC in women with DI may be an 'artefact' caused by the cystometric procedure (catheterization and filling). The question is which measure of MBC is the best for clinical and scientific purposes.