The burden of non-communicable diseases and mortality in people living with HIV (PLHIV) in the pre-, early- and late-HAART era.

OBJECTIVES: To estimate the burden of non-communicable diseases (NCDs) and mortality among PLHIV in the pre-, early- and late-HAART (highly active antiretroviral therapy) era. METHODS: We conducted a cohort study using population-based Danish medical registries including all adult HIV-infected residents of the Central Denmark Region during 1985-2017. For each HIV patient, we selected 10 comparisons from the background population matched by age, sex and municipality of residence. Based on hospital-related diagnoses we estimated the prevalence and incidence of specific NCD at diagnosis and at 5 and 10 years. RESULTS: We identified 1043 PLHIV and 10 430 matched comparisons. PLHIV had lower socioeconomic status and more were born outside western Europe. At HIV diagnosis, 21.9% of PHLIV vs. 18.2% of non-HIV individuals had at least one NCD, increasing to 42.2% vs. 25.9% after 10 years. PLHIV had higher prevalence and cumulative incidence of alcohol abuse, chronic obstructive pulmonary disease (COPD), ischaemic heart disease, mental disorders, renal and liver disease, but no increased risk of diabetes mellitus. Only PLHIV in the age groups 41-50 and > 51 years had an increased incidence of osteoporosis. From the pre- to the late-HAART era, 10-year mortality among PLHIV decreased from 45.5% to 9.4% but continued at more than twice that of uninfected comparisons. However, in the late-HAART era, the mortality of PLHIV who were alive 2 years after HIV diagnosis was approaching that of comparisons. CONCLUSIONS: Even in the late-HAART era, PLHIV have an excess mortality, which may be attributable to several NCDs being more prevalent among PLHIV. The prevalence rates of ischaemic heart disease, diabetes, osteoporosis and renal disease tend to increase over calendar time. Therefore, improvement of survival and quality of life of PLHIV neets strategies to reduce the risk of developing NCDs, including avoiding toxic antiretroviral therapy and lifestyle changes.

Local recurrence rate in a national Danish patient cohort after curative treatment for rectal cancer.

AIM: Several trials have shown that preoperative (chemo)radiotherapy (CRT) reduces local recurrence rates (LRRs) in rectal cancer (RC). The use of CRT varies greatly between countries. It is unknown whether the restrictive use of CRT in Denmark results in a higher LRR relative to other countries. The aim was to evaluate the LRR in a national Danish consecutive cohort of patients with RC. METHODS: All data from patients with RC in Denmark in 2009-2010 who were operated on with curative intent were retrieved from the Danish Colorectal Cancer Group database. Patients with metastases at the time of diagnosis, patients with synchronous colon cancer, and patients, in whom only local surgical procedures were performed, were excluded. In total, 1633 patients met the inclusion criteria. Clinical follow-up was at least five years with a cut-off date of 31 December 2015. RESULTS: Clinical follow-up was 5.4 years (median) with an interquartile range of 4.5-6.1 years. Of all included patients, 479 (29%) were treated with preoperative long-course CRT. Local recurrence was found in 68 patients, resulting in an LRR of 4.2%, and 182 (11%) patients developed distant metastases. Five-year overall survival was 74% (95% CI: 71.64-75.91). CONCLUSIONS: Five-year follow-up of curatively treated patients with RC in Denmark revealed a low LRR. This figure is identical to those reported in other Nordic countries, despite Denmark's considerably stricter guidelines for CRT. The obtained results justify the currently adopted restrictive use of preoperative CRT in Denmark.

Organ-specific responses during brain death: increased aerobic metabolism in the liver and anaerobic metabolism with decreased perfusion in the kidneys.

Hepatic and renal energy status prior to transplantation correlates with graft survival. However, effects of brain death (BD) on organ-specific energy status are largely unknown. We studied metabolism, perfusion, oxygen consumption, and mitochondrial function in the liver and kidneys following BD. BD was induced in mechanically-ventilated rats, inflating an epidurally-placed Fogarty-catheter, with sham-operated rats as controls. A 9.4T-preclinical MRI system measured hourly oxygen availability (BOLD-related R2*) and perfusion (T1-weighted). After 4 hrs, tissue was collected, mitochondria isolated and assessed with high-resolution respirometry. Quantitative proteomics, qPCR, and biochemistry was performed on stored tissue/plasma. Following BD, the liver increased glycolytic gene expression (Pfk-1) with decreased glycogen stores, while the kidneys increased anaerobic- (Ldha) and decreased gluconeogenic-related gene expression (Pck-1). Hepatic oxygen consumption increased, while renal perfusion decreased. ATP levels dropped in both organs while mitochondrial respiration and complex I/ATP synthase activity were unaffected. In conclusion, the liver responds to increased metabolic demands during BD, enhancing aerobic metabolism with functional mitochondria. The kidneys shift towards anaerobic energy production while renal perfusion decreases. Our findings highlight the need for an organ-specific approach to assess and optimise graft quality prior to transplantation, to optimise hepatic metabolic conditions and improve renal perfusion while supporting cellular detoxification.

[Coloanal pouch in surgery of rectal neoplasms]. / Koloanal "pouch" ved operation for rektalt neoplasme.

BACKGROUND: The aim of this study was to evaluate the rate of complications and the functional result after construction of a coloanal J pouch during low anterior resection of the rectum for cancer. DESIGN: A retrospective study of medical records and interviews with patients at follow-up. RESULTS: 32 patients were followed-up for a median of 28 months (range 12-82 months). Two patients (6%) developed anastomotic leakage, one of whom died. Two patients developed rectovaginal fistula, one of whom was given a permanent colostomy. One patient died from complications after closure of the diverting ileostomy. In two patients, local cancer recurred and four died from distant metastases. At follow-up, the frequency of bowel movements was median 2/24 h (range 0.3-4). Three of 29 (10%) experienced intermittent incontinence, whereas none complained of evacuation problems. DISCUSSION: The complication rate was as expected after low anterior rectal resection, but there were unexpected severe complications after closure of the diverting stoma. The functional results were satisfactory and the construction of a colonic J pouch is recommended during low rectal resection, if the defecation pattern and the quality of life is to improve, especially within the first postoperative year.

[Food-borne streptococcal epidemics]. / Levnedsmiddelbåren streptokokepidemi.

Approximately two days after a high school final year farewell party a striking number of pupils and teachers became ill with pharyngitis. The regional public health medical office carried out a questionnaire study with a control group of younger pupils. The regional food control unit studied the preparation and handling at food. Some bacterial cultures received from general practitioners were identified by the regional clinical-microbiological laboratory. Seventy-six percent of the 216 exposed pupils who answered (94% response rate) against 15% of 238 answering in the control group (83% response rate) became ill. The peak incidence was two days after the party. The infectious agent was beta-haemolytic streptoccoci group-A, T-type 25. A salad made of pasta and vegetables that were not cooked and handled properly must have been the vehicle of infection although no salad was left for cultivation. Salads made of pasta must be prepared with great care and effectively cooled. When suspecting a food-borne epidemic, clinicians should immediately inform the regional public health medical office, and the municipal food control unit must take part in the investigations. It is important that bacterial cultures are identified by the regional clinical-microbiological laboratory. It should be considered to make it mandatory that the involved personnel accepts clinical examination and microbiological sampling in cases of suspected food-borne infection.

[Thyroid stimulating antibodies in pregnant women with Graves' disease and neonatal thyrotoxicosis]. / Thyreoideastimulerende antistoffer hos gravide med Graves' sygdom og neonatal tyreotoksikose.

Thyroid stimulating antibodies (TSAb) are thought to be involved in the initiation of Graves' disease, and thyrotoxicosis in the neonatal period is often caused by TSAb passing the placental barrier. We wanted to evaluate measurement of TSAb levels as a possible predictor of neonatal thyrotoxicosis in pregnant patients with Graves' disease. We retrospectively evaluated 18 consecutive pregnant patients with Graves' disease. In 16 patients TSAb were measured in early pregnancy, six had increased values. In 14 of 18 patients normal values were found in late pregnancy and none of the children developed neonatal thyrotoxicosis. Two patients had greatly elevated TSAb values, and their children had neonatal thyrotoxicosis. Two patients had slightly elevated TSAb levels and delivered normal children. We conclude that all pregnant patients with an actual or a history of Graves' disease, should have measured TSAb. High TSAb values in late pregnancy indicate a considerable risk of neonatal thyrotoxicosis.

Colo-colonic intussusception caused by lipoma. Case reports.

Intussusception is primarily seen among children, most often as idiopathic ileocolic intussusception (1, 4), and only 5 to 16% of all intussusceptions are seen in adults (1, 8). In contrast to childhood invagination, in adults underlying pathologic processes are identified in 18 to 90% (1, 8). This report presents 2 cases of colo-colonic intussusception caused by a colonic lipoma. The ultrasonic features of this benign tumour are rather characteristic. A definitive diagnosis can be provided by CT.

[Status of preventive screening for uterine cervix cancer in Denmark in 1994]. / Status for forebyggende undersøgelser mod livmoderhalskraeft i Danmark 1994.

In 1986 The National Board of Health published guidelines for cervical cancer screening in Denmark. These guidelines recommend organized screening with personal invitations every three years to women in the age group 23-59 years, and in the years to come also invitation of women aged 60-74 years. We studied the organization of cervical cancer screening in Danish counties at the beginning of 1994. Organized screening programmes are running in 15 out of the 16 "counties" (this include the municipalities of København and Frederiksberg). Four counties completely follow the national guidelines. Eight counties follow these guidelines in general, but they do not invite women above the age of 60 years. In total, 72% of women aged 25-74 years are at present invited for cervical cancer screening in Denmark.

Thyroid volume and morphology and urinary iodine excretion in a Danish municipality.

In order to throw light upon the eventual need for iodine supplementation in Denmark, four age groups of women (15, 30, 45 and 60 years) from the Holbaek municipality were invited for a clinical and ultrasound study of thyroid volume, structure and function. Of the 570 women invited, 391 accepted and were divided into the following groups: group I: 15 years, N = 113; group II: 30 years, N = 100; group III: 45 years, N = 98; group IV: 60 years, N = 80. The results were as follows the thyroid gland was palpable in 39% and visible in 16% of the entire group; 19% had a family history of thyroid disorders and 7.6% had a previous thyroid disorder. Thyroid volumes (median (range)) as measured by ultrasound were 12 ml (4-29 ml), 18 ml (5-47 ml), 18 ml (7-64 ml) and 18 ml (9-51 ml) in groups I-IV, respectively. The calculated 24-h iodine excretion was 65 micrograms (19-365 micrograms), 88 micrograms (15-274 micrograms), 97 micrograms (40-737 micrograms) and 83 micrograms (50-999 micrograms) in groups I-IV, respectively. An abnormal echo structure was present in 3, 10, 21 and 30%, respectively. Defining a goitre as a thyroid volume above 28 ml indicated a goitre prevalence of 17% in females aged 30-60 years in the Holbaek area of Denmark. Among the 60-year-old women, 3% had a clinically significant goitre (WHO grade III). Thyroid volume did not correlate with iodine excretion. The benefit of iodine supplementation is discussed.

The effect of a community-based cardiovascular disease prevention project in a Danish municipality.

A community-based project for the prevention of cardiovascular diseases was undertaken in 1989 in a rural Danish municipality (Slangerup) with about 8000 inhabitants. Project goals were to draw attention to project activities and improve smoking, eating and exercise behaviours. The intervention was planned using the social learning theory, a communication-behaviour change model and community organisation principle. The strategy used for intervention involved both mass communication and active involvement of the local population in group activities. The objectives of the intervention were assessed by data obtained from representative cross-section surveys in intervention and a control area at baseline (1989) and one year later. More respondents in the intervention (82%) than control (67%) area were aware of local health projects. Ten % reported that they stopped smoking within the last year, 39% ate less fat, and 28% did more exercise, with no differences between intervention and control area. Several explanations are proposed for the limited effect of the project on behaviours. One possible explanation is that the project almost ended up being a pure mass media campaign which may increase awareness, but, as experience shows, may have limited influence on adoption of new behaviour. The Danish population around 1990 is very well informed and educated in this field due to earlier nationwide interventions. No further behavioural effects are obtainable with mass media campaigns.

[Status of preventive examinations against uterine cervix cancer in Denmark]. / Status for forebyggende undersøgelser mod livmoderhalskraeft i Danmark 1991.

In 1986, The Danish National Board of Health published guidelines for cervical cancer screening. These guidelines recommend organized screening with personal invitations every three years to women in the age group 23-59 years, and in the years to come also invitations to women aged 60-74 years. Five years have now elapsed since publication of these guidelines, and we have therefore studied the present organization of cervical cancer screening in Danish counties. Organized screening programmes are now, medio 1991, running in 11 out of the 16 "counties" (this includes the municipalities of Copenhagen and Frederiksberg). One county follows the national guidelines entirely. Six counties follow these guidelines in general, but they do not invite women over the age of 60 years. In all, 45% of women aged 25-74 years are at present invited for cervical cancer screening in Denmark. Two counties have decided to start organized screening programmes in 1992.

[Cardiovascular risk factors--extent and self-assessed risk in relation to prevention of cardiovascular diseases. A questionnaire among 3,956 men and women aged 24-65 years in Vejle County, Slangerup and Helsinge municipalities]. / Kardiovaskulaere risikofaktorer--viden og selvvurderet risiko i relation til forebyggelse af hjerte-kar-sygdomme. En spørgeskemaundersøgelse blandt 3.956 moend og kvinder på 24-65 år i Vejle Amt, Slangerup og Helsinge kommuner.

In autumn 1989, a material of 1,330 men and 1,561 women aged 20-65 years and resident in the County of Vejle replied to a standardized questionnaire about their knowledge and behaviour in relation to prophylaxis of cardiovascular disease. During the same period, 501 men 565 women in the Municipalities of Helsinge and Slangerup participated in a similar investigation. It was investigated whether the behaviours of the participants as regards tobacco, physical activity, diet, experience of stress and overweight were unsuitable in relation to prevention of cardiovascular disease. 22% of the men and 11% of the women had unfavourable behaviour in more than two of these factors. The percentage proportion with many unfavourable factors was greatest among persons with the lowest school education. The majority of the participants were aware of the factors which are of significance for the development of cardiovascular disease. The general level of knowledge was high. A majority of the participants with many unfavourable factors assessed their own risk of development of cardiovascular disease as great. The proportion of the participants who were aware that a personal effort was of significance to retain health was greatest in the group where the behaviour was most suitable both where men an women were concerned.

Significance of incisional biopsy in breast carcinoma: results from a clinical trial with intended excisional biopsy.

The recurrence-free survival rates (RFS) after one-stage mastectomy and partial axillary dissection in 1242 low risk breast cancer patients with invasive ductal carcinoma with or without residual cancer tissue (RCT) in the wall of the biopsy cavity were compared. RFS was significantly lower in patients with RCT (RCT-positive) whether premenopausal (n = 416) or postmenopausal (n = 826). By applying the Cox multivariate analysis on RCT and various known prognostic criteria, the incidence rates for RCT-positive patients relative to RCT-negative patients were estimated. The relative risk by RCT-positivity was in the order of 1.45, indicating that RCT is an independent risk factor contributing an increased risk of recurrence of about 45%.

Histologic malignancy grading of invasive ductal breast carcinoma. A regression analysis of prognostic factors in low-risk carcinomas from a multicenter trial.

In a prospective adjuvant trial including patients with primary operable breast cancer, invasive carcinomas of ductal type were subjected to histological malignancy grading. The parameters investigated were tubule formation, number of mitoses and cell pleomorphism. A Cox regression model for survival data was applied to evaluate the impact of the histological parameters on prognosis in 1809 patients with low-risk carcinomas. Cell pleomorphism proved superior to the other histologic tumor characteristics. It was found that low-risk invasive ductal carcinomas with severe cell pleomorphism had an excess recurrence intensity of 209% relative to carcinomas with no pleomorphism. It is therefore suggested that polymorphous invasive ductal breast carcinomas, other things being equal, should be regarded as high-risk tumors in future clinical trials. Finally it was found that the tripartite malignancy grading 1, 2 and 3 characterizing each of the histological parameters was not equidistant. Consequently, the traditional tripartite histologic scoring needs reconsideration.

Persistence of contact allergy to chromium.

Forty-eight patients with a positive patch test to potassium dichromate 0.5% were retested after 4-7 years; 38 patients (79%) still had a positive patch test. Chromate allergy seems to be persistent. In 72% of the cases a history of occupational exposure to chromates could be proved.