Publications by authors named "Heini Huhtala"

540 Publications

Coeliac disease re-screening among once seronegative at-risk relatives: A long-term follow-up study.

United European Gastroenterol J 2022 May 25. Epub 2022 May 25.

Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.

Background: Serological screening of the relatives of coeliac disease patients is widely endorsed. However, the need for and the optimal timing of possible re-testing of once seronegative at-risk individuals for coeliac disease remain unclear.

Objective: We investigated this issue by inviting a large cohort of previously screening-negative relatives of patients with coeliac disease to participate in a follow-up study.

Methods: Altogether 599 relatives of coeliac disease index patients not diagnosed with coeliac disease in a screening study carried out in 2006-2010 were asked about possible later diagnosis or re-tested with coeliac disease autoantibodies in 2017-2021. Besides incidence, the possible impact of various patient-related clinical factors and HLA haplotype on the later diagnosis or screening positivity was examined.

Results: Fifteen (2.5%) relatives were either diagnosed with a coeliac disease (n = 8) during the follow-up period or were found to be screening-positive in the re-testing (n = 7), giving a combined annual incidence of 221/100,000 person-years in all relatives and 336/100,000 among those carrying coeliac disease-associated HLA DQ2/DQ8. The new cases more often carried the high-risk (DQ2.5/2.5 or DQ2.5/2.2; 35.7% vs. 7.4%, respectively, p < 0.001) HLA and were younger at initial screening (23.3 vs. 40.5 years, p = 0.028) and - in spite of a negative screening outcome - had higher median transglutaminase antibody level in the first study than those not affected. There were no significant differences between the affected and non-affected relatives in other demographic data, degree of kinship with the index, current symptoms or frequency of chronic co-morbidities.

Conclusion: The incidence rate for later coeliac disease diagnosis or new seropositivity in relatives who had been tested once was 221/100,000 person-years in all and 336/100,000 among those carrying at-risk HLA genetics after ∼10 years of follow-up. HLA-typing could help to target a subgroup of relatives who would benefit most from re-testing.
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http://dx.doi.org/10.1002/ueg2.12255DOI Listing
May 2022

Antibiotic prescribing for children with upper respiratory tract infection: a Finnish nationwide 7-year observational study.

Eur J Pediatr 2022 May 23. Epub 2022 May 23.

Department of Pediatrics, Tampere University Hospital, and Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpönkatu 34 (ARVO B235), 33014, Tampere, Finland.

Upper respiratory tract infection (URTI) is a self-limiting viral infection and should not be treated with antibiotics. The aim was to evaluate antibiotic prescriptions for children with uncomplicated URTI in a large nationwide private clinic network between 2014 and 2020. Special focus was given to macrolide prescriptions and costs. The data were obtained from the electronic health records (EHR) of the largest private healthcare company in Finland (with about 250,000 paediatric visits annually across the country). The collected variables included diagnoses, age, visit year, speciality of the doctor, and prescribed antibiotics. The number of uncomplicated URTIs in < 18-year-old children was 156,187 (53.0% in boys). The prescription rate of antibiotics decreased from 18.0% in 2014 to 8.8% in 2020, and that of macrolides from 6.1 to 1.7%. The costs decreased accordingly. Paediatricians prescribed antibiotics less often than general practitioners or ear, nose, and throat specialists.

Conclusion: Antibiotic prescriptions for uncomplicated URTIs, especially macrolides, decreased substantially during the 7-year surveillance period; however, 8.8% of children still received unnecessary antibiotics. To further reduce unwarranted antibiotic prescriptions, active interventions are needed that can be performed by applying the available EHR system.

What Is Known: • Upper respiratory tract infection (URTI) is the most common infection in children. Uncomplicated URTI is a self-limiting viral infection, and antibiotic treatment is not warranted.

What Is New: • Almost 9% of children with uncomplicated URTIs still received unnecessary antibiotics. Paediatricians prescribed antibiotics less often than general practitioners or ear, nose, and throat specialists. To further reduce unwarranted antibiotic prescriptions, active interventions are needed that can be performed by applying the available EHR system.
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http://dx.doi.org/10.1007/s00431-022-04512-wDOI Listing
May 2022

Mortality and causes of death in different celiac disease phenotypes during long-term follow-up.

Dig Liver Dis 2022 May 17. Epub 2022 May 17.

Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.

Background: Celiac disease has been associated with increased mortality, but data on long-term mortality are scarce.

Aims: To determine long-term mortality in celiac disease.

Methods: The study cohort consisted of all celiac disease patients (n=1,392) diagnosed in Tampere University Hospital catchment area 1960 - 2000. Patients were categorized into subgroups based on demographic (age, gender, decade of diagnosis) and celiac disease characteristics (e.g., phenotype, severity of villous atrophy) collected from medical records. Overall and cause-specific mortality was compared to those of age-, sex-, and place of residence matched reference individuals (n=4,177) over time.

Results: During the 41 years of follow-up (median 26.5 years), 376 celiac disease patients and 1,155 reference individuals died. All-cause mortality was not increased (hazard ratio (HR) 0.96, 95% confidence intervals (CI) 0.85-1.08). Mortality from lymphoproliferative diseases and diseases of the central nervous system was increased (HR 2.42, 95% CI 1.38-4.24 and HR 2.14, 95% CI 1.05-4.36 respectively) while the risk from alcohol related diseases was decreased (HR 0.31, 95% CI 0.09-1.00). Examination of various celiac disease phenotypes revealed no significant differences in mortality CONCLUSIONS: Overall mortality was not increased in any celiac disease phenotype during a very long-term follow-up.
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http://dx.doi.org/10.1016/j.dld.2022.04.016DOI Listing
May 2022

The prognostic significance of the electrical QRS axis on long-term mortality in acute coronary syndrome patients - The TACOS study.

J Electrocardiol 2022 May 4;73:22-28. Epub 2022 May 4.

Tampere University, Faculty of Medicine and Health Technology, Finnish Cardiovascular Research Center, Tampere, Finland; Tampere University Hospital, Heart Center, Tampere, Finland.

Introduction: There are several potential causes of QRS-axis deviation in the ECG, but there is limited data on the prognostic significance of QRS-axis deviation in ACS patients.

Subjects And Methods: We evaluated the long-term prognostic significance of acute phase frontal plane QRS-axis deviation and its shift during hospital stay in ACS patients. A total of 1026 patients who met the inclusion criteria were divided into three categories: normal (n = 823), left (n = 166) and right/extreme axis (n = 37).

Results: The median survival time was 9.0 years (95% CI 7.9-10.0) in the normal, 3.6 years (95% CI 2.4-4.7) in the left and 1.3 years (95% CI 0.2-2.4) in the right/extreme axis category. Both short and long-term all-cause mortality was lowest in the normal axis category and highest in the right/extreme axis category. Compared to normal axis, both admission phase QRS-axis deviation groups were independently associated with a higher risk of all-cause mortality. When including left ventricular hypertrophy in the ECG, only the right/extreme axis retained its statistical significance (aHR 1.76; 95% CI 1.16-2.66, p = 0.007). Axis shift to another axis category had no effect on mortality.

Conclusion: In ACS patients, acute phase QRS-axis deviation was associated with higher risk of all-cause mortality. Among the axis deviation groups, right/extreme QRS-axis deviation was the strongest predictor of mortality in the multivariable analysis. Further studies are required to investigate to what extent this association is caused by pre-existing or by ACS-induced axis deviations. QRS-axis shift during hospital stay had no effect on all-cause mortality.
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http://dx.doi.org/10.1016/j.jelectrocard.2022.04.007DOI Listing
May 2022

Interatrial block and P terminal force in the general population - Longitudinal changes, risk factors and prognosis.

J Electrocardiol 2022 Apr 27;73:12-20. Epub 2022 Apr 27.

Faculty of Medicine and Health Technology, Tampere University, Finnish Cardiovascular Research Center, Tampere, Finland; Tays Heart Hospital, Department of Cardiology, Tampere University Hospital, Tampere, Finland.

Background: Partial and advanced interatrial block (IAB) and P terminal force (PTF) in lead V1 are markers of atrial remodeling and risk factors for atrial fibrillation (AF). There is a lack of information about constancy and possible factors influencing the development of these P-wave abnormalities.

Methods: The study sample consisted of 6058 Finnish participants (mean age 52.16 ± 14.60 years, 45.0% male) from the general population with an ECG taken in a health examination, and from 3224 of these participants, who had a re-examination 11 years later. Risk factors for incident partial and advanced IAB and PTF were studied using binomial logistic regression analysis, and the prognostic significance of these ECG changes for new AF was studied using time-varying Cox regression analysis.

Results: The rate of reversal to normal of the studied ECG parameters were 47.4% for partial IAB, 40.0% for advanced IAB and 79.3% for PTF. Age, male sex, hypertension, higher BMI, higher LDL cholesterol, ECG left ventricular hypertrophy, use of beta blocker, and use of angiotensin-converting enzyme inhibitor or angiotensin II receptor antagonist were independently associated with a risk to develop incident P-wave abnormality. Partial IAB was independently associated with increased AF risk (HR 1.28 [95% CI 1.04-1.58]), as was also advanced IAB (HR 1.72 [95% CI 1.07-2.75]).

Conclusion: Traditional cardiovascular risk factors increase the risk of a new P-wave abnormality. Partial and advanced IAB are associated with increased AF risk. Surprisingly, P-wave abnormalities are often reversible during long-term follow-up in the general population.
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http://dx.doi.org/10.1016/j.jelectrocard.2022.04.006DOI Listing
April 2022

Various vascular malformations are prevalent in Finnish pseudoxanthoma elasticum (PXE) patients: a national registry study.

Orphanet J Rare Dis 2022 05 7;17(1):185. Epub 2022 May 7.

Department of Internal Medicine, Tampere University Hospital, Teiskontie 35, 33521, Tampere, Finland.

Background: Pseudoxanthoma elasticum (PXE, OMIM# 264800) is an inborn error of metabolism causing ectopic soft tissue calcification due to low plasma pyrophosphate concentration. We aimed to assess the prevalence of PXE in Finland and to characterize the Finnish PXE population. A nationwide registry search was performed to identify patients with ICD-10 code Q82.84. Information was gathered from available medical records which were requisitioned from hospitals and health centers. Misdiagnosed patients and patients with insufficient records were excluded.

Results: The prevalence of PXE in Finland was 1:260,000 with equal sex distribution. Patients with high conventional cardiovascular risk had more visual and vascular complications than patients with low risk. Four patients (19%) had at least one vascular malformation. A high proportion (33%) of ABCC6 genotypes were of the common homozygous c.3421C > T, p.Arg1141Ter variant. Nine other homozygous or compound heterozygous allelic variants were found.

Conclusions: The prevalence of diagnosed PXE appears to be lower in Finland than in estimates from other countries. Decreased visual acuity is the most prevalent complication. We suggest that various vascular malformations may be an unrecognized feature of PXE.
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http://dx.doi.org/10.1186/s13023-022-02341-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9077871PMC
May 2022

Phrenic nerve stimulation experiences. A single centre, controlled, prospective study.

J Clin Neurosci 2022 May 2;101:26-31. Epub 2022 May 2.

Department of Anaesthesiology, Medical School, University of Tampere, Medisiinarinkatu 3b, 33520 Tampere, Finland. Electronic address:

Patients with central apnoea may use electro ventilation, provided their phrenic nerves and diaphragm muscles are normal. A tendency towards better survival has been found, and both an improved quality of life and facilitated nursing have been claimed with electro ventilation compared to mechanical ventilation. The high investment for the device may form a hurdle for fund providers like our hospital administration board. We, therefore, from our first patient onwards, collected clinically meaningful data in a special register of all patients using electro ventilation and their controls on mechanical ventilation. Since 1988 172 patients left our institution dependent on a respiratory device. Of these, all 48 patients with preserved phrenic nerves chose phrenic nerve stimulation. A patient on mechanical ventilation who agreed to participate was chosen as a control (n = 44). All patients were seen at least once a year. 90 patients suffered high tetraplegia, and 2 suffered central apnoea for other reasons. There is a tendency towards better survival, and there is a lower frequency of decubital ulcers (0.02) and respiratory tract infections (p0.000) with electro than with mechanical ventilation. The frequency of respiratory infections turned out to be a better measure of the quality of respiratory care than survival. The resulting decrease in the need for airway nursing, and the reduced incidence of respiratory infections repaid the high investment in electro ventilation within one year in our setting. Informed patients prefer electro to mechanical ventilation; fund providers might also agree with this preference.
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http://dx.doi.org/10.1016/j.jocn.2022.04.037DOI Listing
May 2022

A Higher Mean Heart Radiation Dose Induces Higher Frequency of Multiple Cardiac Changes.

Anticancer Res 2022 May;42(5):2519-2529

Heart and Lung Center, Helsinki University Central Hospital and Helsinki University, Helsinki, Finland.

Background/aim: Radiotherapy (RT) induces late changes in all cardiac structures. Most studies of early changes focus on individual parameters.

Patients And Methods: Data from eighty early-stage breast cancer patients at baseline, post-RT and three-year follow-up visit were assessed prospectively. Changes in ten cardiac parameters were collected including electrocardiogram (ECG), echocardiography, and biomarkers. A percentage of abnormal changes was calculated.

Results: The mean heart radiation dose (Dmean) was independently associated with the increased incidence of changes post-RT (β=0.403, p<0.001) and at the three-year follow-up (β=0.353, p=0.001). Each 1-Gray increase in Dmean increased the cardiac changes by 3.7% (95%CI=1.9-5.6%) after RT and 3.1% (95%CI=1.3, 4.9%) at the three-year follow-up.

Conclusion: A higher cardiac radiation dose was independently associated with a higher incidence of changes in cardiac parameters. Multiparameter changes imply that the early phase after RT is already characterized by several overlapping cardiac changes.
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http://dx.doi.org/10.21873/anticanres.15730DOI Listing
May 2022

Dynamic Integrated Backscatter Detects Radiotherapy-induced Cardiac Changes Better than Strain Analysis - A Prospective Three-year Study.

Anticancer Res 2022 May;42(5):2507-2517

Heart and Lung Center, Helsinki University Central Hospital and Helsinki University, Helsinki, Finland.

Background/aim: Radiotherapy (RT) related myocardial changes were analyzed by deformation imaging echocardiography in this study.

Patients And Methods: Ninety-nine breast cancer patients were studied at baseline, after chemotherapy, after RT, and three years after RT (3Y). Eighty patients received RT only, and twenty patients had right-sided breast cancer. Echocardiography included cyclic variation of the integrated backscatter in the septum (sCV) and posterior wall (pCV), global longitudinal strain (GLS), and left ventricular ejection fraction (LVEF).

Results: In patients with left-sided breast cancer, sCV declined from 11.3±3.3 dB at baseline to 10.3±2.9 dB after RT (p=0.001). No changes were observed after chemotherapy (p=0.211) or in patients with right-sided breast cancer after RT (p=0.977). No other parameters declined after RT. The decline in sCV was independently associated with the left anterior descending coronary artery radiation dose (β=-0.290, p=0.020).

Conclusion: In contrast to other parameters, sCV correlated with heart radiation dose.
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http://dx.doi.org/10.21873/anticanres.15729DOI Listing
May 2022

Lower Urinary Tract Symptoms and Mortality among Finnish Men: The Roles of Symptom Severity and Bother.

J Urol 2022 06 26;207(6):1285-1294. Epub 2022 Apr 26.

Department of Urology, Tampere University Hospital, Tampere, Finland.

Purpose: The utility of male lower urinary tract symptoms (LUTS) as mortality risk factors remains unclear. We explored LUTS-associated mortality among Finnish men, evaluating the association of symptom severity and bother with risk of death.

Materials And Methods: A questionnaire including the Danish Prostatic Symptom Score was mailed to a population-based cohort of 3,143 men aged 50, 60 and 70 years in 1994, with repeat surveys in 1999, 2004, 2009 and 2015. The men were followed until the end of 2018. Mortality associated with LUTS was analyzed using time-dependent Cox regression adjusted for age and comorbidity, updating symptom data every 5 years, including interaction terms between symptoms and associated bother.

Results: Of the 1,167 men in the analysis, 591 (50.6%) died during the 24-year followup. In analyses of moderate and severe symptoms disregarding bother, overall voiding and storage LUTS, daytime frequency and urgency incontinence were associated with increased mortality: the multivariable-adjusted hazard ratios were 1.19 (95% CI 1.00-1.40), 1.35 (1.13-1.62), 1.31 (1.09-1.58) and 2.19 (1.42-3.37), respectively. In analyses disregarding symptom severity and bother, voiding LUTS were associated with decreased mortality, while daytime frequency and nocturia were associated with increased mortality: the HRs were 0.82 (95% CI 0.67-1.00), 1.31 (95% CI 1.09-1.58) and 1.52 (95% CI 1.21-1.91), respectively. Excess mortality associated with bothersome daytime frequency and nocturia tended to be slightly higher: the HRs were 1.86 (95% CI 1.41-2.47) and 1.88 (95% CI 1.38-2.58), respectively. No significant interactions were found between symptoms and associated bother, however.

Conclusions: Moderate and severe LUTS are potential risk factors for mortality, independently of their bother.
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http://dx.doi.org/10.1097/JU.0000000000002450DOI Listing
June 2022

Frequency and clinical significance of histologic upper gastrointestinal tract findings in children with inflammatory bowel disease.

Scand J Gastroenterol 2022 Mar 31:1-5. Epub 2022 Mar 31.

Department of Medicine and Health Technology, Tampere Center for Child, Adolescent, and Maternal Health Research, Tampere University, Tampere, Finland.

Objective: Assessment of the upper gastrointestinal tract (UGI) may enable more personalized treatment strategies in pediatric inflammatory bowel disease (IBD). However, data on the frequency and significance of these findings remain limited.

Methods: Data on 132 pediatric IBD patients with systematic UGI sampling were collected and the baseline characteristics and presence of complications compared between those with and without histological UGI findings. The control group comprised 162 children who received no diagnoses.

Results: Seventy-six children had ulcerative colitis (UC), 47 Crohn's disease (CD) and nine IBD unclassified. UGI findings were more common in IBD patients than controls (69.7% vs. 30.9%, respectively,  < .001), particularly in the stomach (62.1% vs. 16.8%;  < .001). Among IBD patients, findings were more common in CD than in UC (80.9% vs. 63.2%;  = .038), particularly in the duodenum (21.3% vs. 2.6%,  = .001). Four patients had UGI granulomas consistent with CD. Hypoalbuminemia (OR 3.22; 95% CI 1.18-8.79) and failure to thrive (2.82; 1.17-6.78) increased the likelihood of UGI findings in IBD. In CD, perianal morbidity was less common in those with than in those without UGI findings (13.2% vs. 44.4%;  = .032) whereas in UC, UGI findings increased the risk for co-morbidities (18.8% vs. 3.6%;  = .059). The long-term outcomes did not differ between patients with or without UGI findings.

Conclusions: Histologic UGI findings were more common in children with IBD than in children with no gastrointestinal diagnoses. In CD, UGI findings were more frequent than in UC, especially in the duodenum. In UC, UGI findings were associated with more complex disease.
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http://dx.doi.org/10.1080/00365521.2022.2057197DOI Listing
March 2022

+Gz Exposure and Flight Duty Limitations.

Aerosp Med Hum Perform 2022 Apr;93(4):390-395

High +G exposure is known to cause spinal problems in fighter pilots, but the amount of tolerable cumulative +G exposure or its intensity is not known. The aims of this study were to assess possible breaking points during a flight career and to evaluate possible determinants affecting pilots' spines. Survival analysis was performed on the population who started their jet training in 1995-2015. The endpoint was permanent flight duty restriction due to spinal disorder. Then the quantified G exposure and possible confounding factors were compared between those pilots with permanent flying restriction and their matched controls. Cumulative G exposure was measured sortie by sortie with fatigue index (FI) recordings. FI is determined by the number of times certain levels of G are exceeded during the sorties. The linear trend of the survival curve indicates an annual 0.86% drop out rate due to spinal problems among the fighter pilot population. A conditional logistic regression did not find any difference in the FI between cases and controls (OR 0.96, 95%CI 0.87-1.06). No statistical difference was found for flight hours, a sum of intensive flying periods, fitness tests, or with nicotine product use. Additionally, a maximum +G limitation without airframe restriction was assessed and is presented as a useful tool to manage loading and developed symptoms. No particular breaking point during follow-up or individual factor was found for G induced spinal disorders. The results of the study outline the multifactorial nature of the problem. Thus, multifactorial countermeasures are also needed to protect pilots' health.
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http://dx.doi.org/10.3357/AMHP.5915.2022DOI Listing
April 2022

Alcohol Consumption and Its Influence on the Clinical Picture of Puumala Hantavirus Infection.

Viruses 2022 02 28;14(3). Epub 2022 Feb 28.

Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland.

Puumala hantavirus (PUUV) causes hemorrhagic fever with renal syndrome. Characteristic clinical findings include acute kidney injury (AKI), thrombocytopenia, and capillary leakage. Smoking increases the risk of severe AKI, but it is not known whether alcohol consumption predisposes patients to a more severe infection. Liver and pancreatic enzymes, as well as biomarkers of alcohol consumption (gamma-glutamyl transferase, GGT; carbohydrate-deficient transferrin, CDT; GGT-CDT combination; and ethyl glucuronide, EtG), were measured from 66 patients with acute PUUV infection during hospitalization and at the convalescence phase. Alcohol consumption was present in 41% of the study population, 15% showing signs of heavy drinking. Alcohol use did not affect the severity of PUUV induced AKI nor the overall clinical picture of the infection. Liver enzyme levels (GGT or alanine aminotransferase, ALT) were elevated in 64% of the patients, but the levels did not associate with the markers reflecting the severity of the disease. Serum amylase activities at the convalescent stage were higher than those at the acute phase ( < 0.001). No cases with acute pancreatitis were found. In conclusion, our findings indicate that alcohol consumption does not seem to affect the clinical course of an acute PUUV infection.
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http://dx.doi.org/10.3390/v14030500DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8948946PMC
February 2022

Platelet count is not associated with delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as defined by the 2010 consensus definition.

J Neurol Sci 2022 05 15;436:120227. Epub 2022 Mar 15.

Tampere University Hospital, Department of Intensive Care, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.

Background: Although delayed cerebral ischemia (DCI) commonly complicates recovery in survivors of aneurysmal subarachnoid hemorrhage (aSAH), its pathophysiology is incompletely understood. Previous studies examining the association of DCI and platelet count have demonstrated contradictory results. This study aimed to investigate this association in a cohort of aSAH patients using the 2010 consensus definition of DCI.

Methods: We conducted a retrospective single-center observational study of consecutive adult aSAH patients admitted to the intensive care unit from January 2010 to December 2014. Platelet count and DCI evaluations were performed daily in the first 14 days after admission. DCI was defined according to the 2010 consensus criteria.

Results: A total of 340 patients were included for analysis. DCI incidence was 37.1%. Platelet count was not significantly associated with occurrence of DCI on any day. Mean platelet count was lowest on day 3 after aSAH and then increased to exceed the count at admission on day 6. Treatment modality and use of dual antiplatelet therapy were not associated with DCI.

Conclusions: Platelet count was not associated with DCI as defined by the 2010 consensus criteria. Future studies adhering to the 2010 consensus definition of DCI are needed to clarify the role of platelets and platelet function in DCI pathophysiology.
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http://dx.doi.org/10.1016/j.jns.2022.120227DOI Listing
May 2022

Single-administered GnRH agonist as luteal phase support in insemination cycles: a randomized controlled trial.

Gynecol Endocrinol 2022 May 24;38(5):438-442. Epub 2022 Mar 24.

Department of Obstetrics and Gynaecology, Tampere University Hospital, Tampere, Finland.

Objective: To find out whether a single-administered GnRH agonist improves the live birth rate in real-life patients undergoing intrauterine insemination (IUI) cycles.

Study Design: A prospective, randomized controlled trial in a public single tertiary center in Tampere University Hospital, Finland. Altogether 251 IUI cycles in 163 patients were randomized to triptorelin and a control group between January 2017 and April 2019. In the triptorelin group, the participants had a single administration of a subcutaneous GnRH agonist triptorelin 0.1 mg at the time of implantation. In the control group, there was no luteal phase support. The primary outcome measure was the live birth rate (LBR). The secondary outcome measures were clinical pregnancy rate (CPR) and miscarriage rate.

Results: Overall, the live birth rate was lower in the triptorelin group compared to the control group (7.9 vs. 12.1%;  = .297). The clinical pregnancy rates were 12.6 and 13.7%, respectively. There were 2.4% miscarriages in the triptorelin group and no miscarriages in the control group. Ovarian stimulation with letrozole was associated with lower LBR among the triptorelin group, in comparison to the control group (0 vs. 14.7%,  = .020). In contrast, when gonadotrophin was added to the letrozole, LBR was almost doubled compared to the control group (15.9 vs. 8.3%,  = .341).

Conclusion: A single administration of GnRH agonist in the luteal phase does not improve LBR in IUI cycles.
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http://dx.doi.org/10.1080/09513590.2022.2054984DOI Listing
May 2022

Clinical Relevance of Anti-Gliadin Seropositivity in the Ageing Population: A Long-term Follow-up Study.

J Gastrointestin Liver Dis 2022 03 19;31(1):11-17. Epub 2022 Mar 19.

Department of Internal Medicine, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.

Aims: To explore if anti-gliadin antibody (AGA) positivity is associated with overall mortality or morbidity and especially with the development of coeliac disease during long-term gluten exposure.

Methods: The study population comprised 130 persistently AGA-positive but transglutaminase-2 (anti- TG2) -negative and 52 persistently AGA- and anti-TG2 -negative subjects aged 64-88 years. HLA-typing for DQ2 and DQ8 (coeliac-type HLA) was performed on the AGA-positives. The medical records of the study population were reviewed to compare mortality and morbidity during a long-term follow-up of 12-13 years since the initial antibody analysis.

Results: Mortality or cumulative prevalence of gastroenterological, autoimmune, psychiatric, cardiovascular or any malignant diseases did not differ statistically between the AGA-positives and the AGA-negatives. Neurological diseases were more common in the AGA-negative group (p=0.017), but there was no statistical difference between the prevalence of any particular neurological diseases. Coeliac-type HLA in AGA-positive subjects did not influence mortality or morbidity. However, during the last six to seven years the incidence of immunological diseases was more common in the AGA-positive subjects without coeliac-type HLA than in those with coeliac-type HLA, or in the AGA-negative group (p=0.020). None of the persistently AGA-positive subjects developed clinically diagnosed coeliac disease.

Conclusions: Gliadin antibody positivity without coeliac disease does not predict mortality or morbidity in the ageing population continuing to consume gluten for over ten years.
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http://dx.doi.org/10.15403/jgld-4025DOI Listing
March 2022

Antibiotic prescriptions for children with lower respiratory tract infections fell from 2014 to 2020, but misuse was still an issue.

Acta Paediatr 2022 Jun 11;111(6):1230-1237. Epub 2022 Mar 11.

Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Department of Pediatrics, and Tampere University, Tampere University Hospital, Tampere, Finland.

Aim: We evaluated main trends in antibiotic prescriptions for children with lower respiratory tract infection (LRTI) by Terveystalo, Finland's largest private healthcare company.

Methods: The study comprised of 89,359 children aged 0-17 years (57.2% boys) who visited Terveystalo primary care clinics from 2014 to 2020 with LRTI. The data were assessed by age, study year, location, the doctor's speciality and whether the diagnosis was bronchitis or community-acquired pneumonia (CAP).

Results: There were gradual decreases in overall antibiotic prescription rates during the study period (37.0% in 2014 vs. 20.1% in 2020) and in prescribed macrolides (16.8% vs. 7.5%). Altogether, 31.3% of 72,737 children with bronchitis and 22.5% of those 16,622 with CAP-received antibiotics. Macrolides were the most frequently prescribed antibiotics for bronchitis, at more than 40%, without any substantial relative decrease during the study. Costs of antibiotics increased from 2014 to 2016 and then decreased in line with the reduction in prescriptions. However, there was still a marked overuse of antibiotics, especially macrolides, for children with bronchitis. The relative use of amoxicillin for CAP increased from 41.4% to 65.4% between 2016 and 2020, in line with current guidelines.

Conclusion: Despite an overall reduction in prescribed antibiotics, some antibiotics were still overused, particularly macrolides for bronchitis.
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http://dx.doi.org/10.1111/apa.16323DOI Listing
June 2022

Advising and limiting medical treatment during phone consultation: a prospective multicentre study in HEMS settings.

Scand J Trauma Resusc Emerg Med 2022 Mar 9;30(1):16. Epub 2022 Mar 9.

Emergency Medical Services, Centre for Prehospital Emergency Care, Department of Emergency, Anaesthesia and Pain Medicine, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland.

Background: We investigated paramedic-initiated consultation calls and advice given via telephone by Helicopter Emergency Medical Service (HEMS) physicians focusing on limitations of medical treatment (LOMT).

Methods: A prospective multicentre study was conducted on four physician-staffed HEMS bases in Finland during a 6-month period.

Results: Of all 6115 (mean 8.4/base/day) paramedic-initiated consultation calls, 478 (7.8%) consultation calls involving LOMTs were included: 268 (4.4%) cases with a pre-existing LOMT, 165 (2.7%) cases where the HEMS physician issued a new LOMT and 45 (0.7%) cases where the patient already had an LOMT and the physician further issued another LOMT. The most common new limitation was a do-not-attempt cardiopulmonary resuscitation (DNACPR) order (n = 122/210, 58%) and/or 'not eligible for intensive care' (n = 96/210, 46%). In 49 (23%) calls involving a new LOMT, termination of an initiated resuscitation attempt was the only newly issued LOMT. The most frequent reasons for issuing an LOMT during consultations were futility of the overall situation (71%), poor baseline functional status (56%), multiple/severe comorbidities (56%) and old age (49%). In the majority of cases (65%) in which the HEMS physician issued a new LOMT for a patient without any pre-existing LOMT, the physician felt that the patient should have already had an LOMT. The patient was in a health care facility or a nursing home in half (49%) of the calls that involved issuing a new LOMT. Access to medical records was reported in 29% of the calls in which a new LOMT was issued by an HEMS physician.

Conclusion: Consultation calls with HEMS physicians involving patients with LOMT decisions were common. HEMS physicians considered end-of-life questions on the phone and issued a new LOMT in 3.4% of consultations calls. These decisions mainly concerned termination of resuscitation, DNACPR, intubation and initiation of intensive care.
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http://dx.doi.org/10.1186/s13049-022-01002-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8905861PMC
March 2022

Prevalence and Clinical Significance of Helicobacter Pylori-negative Chronic Gastritis in Children.

J Pediatr Gastroenterol Nutr 2022 05 3;74(5):949-955. Epub 2022 Mar 3.

Tampere Centre for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.

Objectives: The clinical significance of Helicobacter pylori-negative chronic gastritis (HPNCG) in children is unclear. We examined this issue in patients who had undergone esophagogastroduodenoscopy with systematic gastric sampling.

Methods: Data of 1178 consecutive children who underwent diagnostic esophagogastroduodenoscopy were collected. Baseline characteristics and long-term outcomes were compared between children with active and inactive HPNCG and those with normal gastric histology. Follow-up data were available for up to 13 years.

Results: Altogether 24 (2.0%) children had active and 235 (19.9%) inactive HPNCG, 27 (2.3%) were Hpylori-positive, 46 (3.9%) had other gastric pathology, and 846 (71.8%) normal histology. Diarrhea (31.3% vs 25.1%, P  = 0.033), poor growth (23.6% vs 14.7%, P  < 0.001), bloody stools (13.9% vs 7.2%, P < 0.001), anemia (46.5% vs 23.4%, P < 0.001), hypersedimentation (39.7% vs 21.4%, P < 0.001), hypoalbuminemia (40.4% vs 16.2%, P < 0.001), and elevated fecal calprotectin (62.4% vs 31.5%, P < 0.001) were more common and heartburn (13.9% vs 22.9%, P = 0.002) less common in the HPNCG group than in the controls. Both active (OR 3.64,95% CI 1.35-9.82) andinactive (2.98, 2.18-4.08) HPNCG predicted a diagnosis in the initial investigations. Crohn disease (41.7%) was the most common diagnosis in active HPNCG and celiac disease (37.4%) in inactive HPNCG. During follow-up, 7 (9.9%) of the 71 initially nondiagnosed HPNCG children received a diagnosis.

Conclusions: HPNCG is a frequent finding in children undergoing EGD, the active form being associated especially with Crohn disease and the inactive with celiac disease. The long-term prognosis of patients with HPNCG who do not receive an initial diagnosis is good.
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http://dx.doi.org/10.1097/MPG.0000000000003440DOI Listing
May 2022

Combining biological therapies in patients with inflammatory bowel disease: a Finnish multi-centre study.

Scand J Gastroenterol 2022 Mar 3:1-6. Epub 2022 Mar 3.

Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.

Background And Aims: Therapy with two concomitant biologicals targeting different inflammatory pathways has emerged as a new therapy option for treatment refractory inflammatory bowel disease (IBD). Data on the efficacy and safety of dual biological therapy (DBT) are scarce and are investigated in this study.

Materials And Methods: Data on all patients treated with a combination of two biologicals in four Finnish tertiary centres were collected and analysed. Remission was assessed by a physician on the basis of biomarkers, endoscopic evaluation and alleviation of symptoms.

Results: A total of 16 patients with 22 trials of DBT were included. Fifteen patients had Crohn's disease. The most common combination of DBT was adalimumab (ADA) and ustekinumab (USTE; 36%) with median follow-up of nine months (range 2-31). Altogether seven (32%) patients were in remission at the end of follow-up and in two trials response to DBT was assessed to be partial with the relief of patient symptoms. In a total of four trials DBT reduced the need for corticosteroids. The majority of patients achieving a response to DBT were treated with the combination of ADA and USTE (56%). At the end of follow-up all nine (41%) patients responding to DBT continued treatment. Infection complications occurred in three patients (19%).

Conclusion: DBT is a promising alternative treatment for refractory IBD, and half of our patients benefitted from it. More data on the efficacy and safety of DBT are needed especially in long-term follow up.
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http://dx.doi.org/10.1080/00365521.2022.2045350DOI Listing
March 2022

Prevalence and long-term prognostic implications of prolonged QRS duration in left ventricular hypertrophy: a population-based observational cohort study.

BMJ Open 2022 02 28;12(2):e053477. Epub 2022 Feb 28.

Faculty of Medicine and Health Technology, Tampere University, and Finnish Cardiovascular Research Center, Tampere, Finland.

Objectives: ECG left ventricular hypertrophy (ECG-LVH) has been associated with left ventricular dysfunction and adverse prognosis, but little is known about the prevalence and prognostic significance of different levels of QRS duration in the presence of ECG-LVH in a general population.

Design: Population-based observational prospective cohort study.

Participants: Nationally representative random cluster of Finnish adult population.

Methods: We assessed the prevalence and long-term (median 15.9 years) prognostic significance of QRS duration in ECG-LVH, and compared the risk to individuals without ECG-LVH in a predominantly middle-aged random sample of 6033 Finnish subjects aged over 30 years (mean age 52.2, SD 14.6 years), who participated in a health examination including a 12-lead ECG.

Main Outcome Measures: Cardiovascular and all-cause mortality, incidence of heart failure (HF).

Results: ECG-LVH was present in 1337 (22.2%) subjects; 403 of these (30.1%) had QRS duration ≥100 ms and 100 (7.5%) had ≥110 ms. The increased risk of mortality in ECG-LVH became evident after a QRS threshold of ≥100 ms. After controlling for known clinical risk factors, QRS 100-109 ms was associated with increased cardiovascular (HR 1.38, 95% CI 1.01 to 1.88, p=0.045) and QRS≥110 ms with cardiovascular (1.74, 95% CI 1.07 to 2.82, p=0.025) and all-cause mortality (1.52, 95% CI 1.02 to 2.25, p=0.039) in ECG-LVH. The risk of new-onset HF was two-fold in subjects with QRS 100-109 ms and threefold in subjects with QRS ≥110 ms, even after adjustment for incident myocardial infarction within the follow-up. When the prognosis was compared with subjects without ECG-LVH, subjects with ECG-LVH but QRS duration <100 ms displayed similar mortality rates with or without ECG-LVH but higher rates of incident HF.

Conclusions: In ECG-LVH, the risk of excess mortality and new-onset HF markedly increases with longer QRS duration, but even QRS duration within normal limits in ECG-LVH carried a risk of HF compared with the risk in individuals without ECG-LVH.
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http://dx.doi.org/10.1136/bmjopen-2021-053477DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8886432PMC
February 2022

Endocervical Cytology: Inter- and Intra-Observer Variability in Conventional Pap Smears.

Acta Cytol 2022 28;66(3):206-215. Epub 2022 Feb 28.

Department of Pathology, Fimlab Laboratories, Tampere, Finland.

Introduction: Although the cytological diagnostic criteria for cervical squamous and glandular lesions are established by the Bethesda System for Reporting Cervical Cytology, the reproducibility of the diagnosis of these lesions has been shown to be variable in previous studies. At best, occasional good kappa (κ) values were reached both inter- and intra-observerly. Generally, consensus on high-grade lesions has been better compared to milder changes.

Methods: Altogether, 167 conventional Pap smears from 50 patients with histologically confirmed endocervical adenocarcinomas (EAC) and adenocarcinomas in situ (AIS) and from 28 patients with histologically proven high-grade intraepithelial lesions were analyzed by four cytopathologists. Twenty of the smears were later re-evaluated by the same cytopathologists. κ-values between cytopathologists in the categories of squamous versus glandular, negative for intraepithelial lesion or malignancy (NILM), atypical, and preneoplastic/neoplastic were calculated. The diagnostic Pap smears of EAC and AIS with best and worst consensus between observers were then morphologically analyzed.

Results: The reproducibility ranged from poor to substantial. The overall κ-values between the four cytopathologists were 0.412, 0.314, 0.272, and 0.082, respectively, in the categories of preneoplastic/neoplastic, squamous versus glandular, NILM, and atypical. Overall intra-observer κ-values were correspondingly 0.491, 0.616, 0.345, and 0.241. In the diagnostic smears of AIS and EAC, the nuclear size >2 times the normal and nuclear pleomorphism were the commonest features associated with good diagnostic consensus and the lack of nuclear enlargement and degenerative changes were associated with poor consensus.

Conclusions: The reproducibility of preneoplasia/neoplasia diagnoses was better than that of atypia and NILM both in the inter- and intra-observer part in this study. In the smears from AIS and EAC patients, general neoplasia-associated features were more common in samples with good agreement by the four cytopathologists of the neoplastic nature and the endocervical origin of the lesion.
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http://dx.doi.org/10.1159/000522212DOI Listing
May 2022

Impact of obesity on uterine contractile activity during labour: A blinded analysis of a randomised controlled trial cohort.

BJOG 2022 Feb 23. Epub 2022 Feb 23.

Department of Obstetrics and Gynaecology, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.

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http://dx.doi.org/10.1111/1471-0528.17128DOI Listing
February 2022

Comparison of zero heat flux and double sensor thermometers during spinal anaesthesia: a prospective observational study.

J Clin Monit Comput 2022 Jan 3. Epub 2022 Jan 3.

Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland.

Because of the difficulties involved in the invasive monitoring of conscious patients, core temperature monitoring is frequently neglected during neuraxial anaesthesia. Zero heat flux (ZHF) and double sensor (DS) are non-invasive methods that measure core temperature from the forehead skin. Here, we compare these methods in patients under spinal anaesthesia. Sixty patients scheduled for elective unilateral knee arthroplasty were recruited and divided into two groups. Of these, thirty patients were fitted with bilateral ZHF sensors (ZHF group), and thirty patients were fitted with both a ZHF sensor and a DS sensor (DS group). Temperatures were saved at 5-min intervals from the beginning of prewarming up to one hour postoperatively. Bland-Altman analysis for repeated measurements was performed and a proportion of differences within 0.5 °C was calculated as well as Lin`s concordance correlation coefficient (LCCC). A total of 1261 and 1129 measurement pairs were obtained. The mean difference between ZHF sensors was 0.05 °C with 95% limits of agreement - 0.36 to 0.47 °C, 99% of the readings were within 0.5 °C and LCCC was 0.88. The mean difference between ZHF and DS sensors was 0.33 °C with 95% limits of agreement - 0.55 to 1.21 °C, 66% of readings were within 0.5 °C and LCCC was 0.59. Bilaterally measured ZHF temperatures were almost identical. DS temperatures were mostly lower than ZHF temperatures. The mean difference between ZHF and DS temperatures increased when the core temperature decreased.Trial registration: The study was registered in ClinicalTrials.gov on 13th May 2019, Code NCT03408197.
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http://dx.doi.org/10.1007/s10877-021-00799-6DOI Listing
January 2022

Detection and Outcome of Endocervical Atypia in Cytology in Primary HPV Screening Programme.

Diagnostics (Basel) 2021 Dec 20;11(12). Epub 2021 Dec 20.

Pathology, Fimlab Laboratories, Arvo Ylpön katu 4, 33520 Tampere, Finland.

Most endocervical adenocarcinomas (EAC) are associated with high-risk HPV (hrHPV) infection, with HPV genotypes 16, 18 and 45 accounting for >90% of the cases. Among endocervical glandular lesions, screening with hrHPV test has previously shown to predict the outcome better than cytology, although around one-fifth of the EAC remain negative both in hrHPV testing and cytology. The study consists of two consecutive HPV-primary screening rounds, conducted in 2012-2015 and 2017-2020. Of the 87 women aged 35 to 60 years of age diagnosed with Atypical endocervical cells, NOS or Atypical endocervical cells, favor neoplastic cytology during the first screening round, 63 (72.4%) were hrHPV positive and 24 (27.6%) were hrHPV negative. Among hrHPV positive patients, three EAC, two adenocarcinomas in situ (AIS), one AIS + high-grade intraepithelial lesion (HSIL) and 13 HSIL were found. Of the histologically verified lesions, 68.4% (13/19) were purely of squamous origin. All the EAC and AIS were HPV16 or HPV 18 positive. No high-grade histological lesions were found among the hrHPV negative patients with cytological glandular atypia. A later database search revealed one HPV-negative, gastric-type mucinous EAC that was missed by the HPV primary screening.
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http://dx.doi.org/10.3390/diagnostics11122402DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8700048PMC
December 2021

Cough and cold medicine prescription rates can be significantly reduced by active intervention.

Eur J Pediatr 2022 Apr 15;181(4):1531-1539. Epub 2021 Dec 15.

Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Arvo Ylpönkatu 34 (ARVO B235), 33014, Tampere, Finland.

Our aim was to construct and test an intervention programme to eradicate cough and cold medicine (CCM) prescriptions for children treated in a nationwide healthcare service company. The study was carried out in the largest private healthcare service company in Finland with a centralised electronic health record system allowing for real-time, doctor-specific practice monitoring. The step-by-step intervention consisted of company-level dissemination of educational materials to doctors and families, educational staff meetings, continuous monitoring of prescriptions, and targeted feedback. Outreach visits were held in noncompliant units. Finally, those physicians who most often prescribed CCM were directly contacted. During the intervention period (2017-2020), there were more than one million paediatric visits. Prescriptions of CCMs to children were completely eradicated in 41% of units and the total number of CCM prescriptions decreased from 6738 to 744 (89%). During the fourth intervention year, CCMs containing opioid derivatives were prescribed for only 0.2% of children aged < 2 years. The decrease in prescriptions was greatest in general practitioners (5.2 to 1.1%). In paediatricians, the prescription rates decreased from 1.5 to 0.2%. The annual costs of CCMs decreased from €183,996 to €18,899 (89.7%). For the intervention, the developers used 343 h and the attended doctors used 684 h of work time during the 4-year intervention. The costs used for developing, implementing, reporting, evaluating, communicating, and data managing formed approximately 11% of total intervention costs.

Conclusion: The study showed that a nationwide systematic intervention to change cough medicine prescription practices is feasible and requires only modest financial investments.

What Is Known: • Cough and cold medicines (CCM) are not effective or safe, especially for children aged 6 years. • Although the use of CCMs has been declining, caregivers continue to administer CCMs to children, and some physicians still prescribe them even for preschool children.

What Is New: • A nationwide systematic intervention can significantly and cost effectively change CCM prescription habits of paediatricians, general practitioners, and other specialists. • Electronic health records provide additional tools for operative guideline implementation and real-time quality monitoring, including recommendations of useless or harmful treatments.
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http://dx.doi.org/10.1007/s00431-021-04344-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8673918PMC
April 2022

Dissecting the contribution of single nucleotide polymorphisms in and genomic regions to the celiac disease phenotype.

J Transl Autoimmun 2021 14;4:100128. Epub 2021 Oct 14.

Celiac Disease Research Center, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.

Purpose And Objectives: Given their role in homing immune cells to the intestine, CC motif chemokine receptor 9 (CCR9) and its specific ligand CC motif chemokine ligand 25 (CCL25) are interesting candidate genes for celiac disease. These genes are located in regions previously shown to be associated with or linked to celiac disease, but no investigations on their association with various celiac disease phenotypes have so far been conducted. Here we studied such associations of both genotyped and imputed single nucleotide polymorphisms (SNPs) with either regulatory function or exonic location of the and loci.

Results: Exploiting a carefully phenotyped cohort of 625 celiac disease patients and 1817 non-celiac controls, we identified that multiple SNPs with predicted regulatory function (RegulomeDB score ≤3a and/or eQTL effect) located between 100 kB upstream and downstream of and are associated with celiac disease and/or selected phenotypes. Of the genotyped SNPs in the loci, rs213360 with an eQTL effect on expression in blood was associated with celiac disease and all investigated phenotypes except high HLA risk. Rs1545985 with an eQTL on expression and rs7652331 and rs12493471, both with RegulomeDB score ≤3a, were all associated with gastrointestinal symptoms and malabsorption and the latter additionally with anemia. The genotyped SNPs rs952444 and rs882951, with RegulomeDB scores 1d and 1f respectively and eQTL effect on expression in small intestine, were associated with gastrointestinal symptoms and malabsorption. The SNP rs2303165 identified in sequencing followed by imputation was associated with partial villous atrophy. However, the association did not pass the permutation based multiple testing correction (P > 0.05).

Conclusions: We conclude that SNPs in the region of and with predicted functional effect or exonic localization likely contribute only modestly to various celiac disease phenotypes.
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http://dx.doi.org/10.1016/j.jtauto.2021.100128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8640869PMC
October 2021

Multiple Chemical Sensitivity in Patients Exposed to Moisture Damage at Work and in General Working-Age Population-The SAMDAW Study.

Int J Environ Res Public Health 2021 11 23;18(23). Epub 2021 Nov 23.

Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland.

A considerable proportion of patients having respiratory tract or voice symptoms associated with workplace moisture damage (MD) could have multiple chemical sensitivity (MCS). MCS is characterized by symptoms of different organ systems in association with low-level chemical exposure. The objective of this study was to assess the prevalence of MCS among patients referred to secondary health care because of respiratory or voice symptoms associated with workplace MD compared to the general working-age population. Using three subscales of the QEESI© questionnaire, we assessed MCS in the study patients and 1500 controls in the same district randomly selected from the Finnish Population Information System. Study patients had significantly more often high scores in chemical intolerance (39% vs. 23%, = 0.001), symptom severity (60% vs. 27%, < 0.001), and life impact subscales (53% vs. 20%, < 0.001). Asthma, chronic rhinosinusitis, laryngeal problems, and atopy were not associated with the presence of MCS. MCS is common among patients referred to secondary health care with respiratory tract and/or voice symptoms associated with workplace MD, and it considerably affects their everyday life. MCS should be considered as a possible explanatory factor for MD-associated symptoms.
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http://dx.doi.org/10.3390/ijerph182312296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8657242PMC
November 2021

Glucose management team significantly improves glycaemic care and commitment to in-hospital guidelines within arthroplastic patients.

Acta Anaesthesiol Scand 2022 Mar 21;66(3):326-336. Epub 2021 Dec 21.

Faculty of Medicine, Tampere University, Tampere, Finland.

Background: Perioperative dysglycaemias are a risk for harm but guidelines to improve glucose management are poorly adhered to.

Aim: To determine whether a specialized team and diabetes education improves the implementation of guidelines and glucose values.

Methods: We conducted a prospective study of 611 nonselected, consecutive patients attending for elective hip or knee arthroplasty. The first 209 patients received conventional care and the following 402 patients received intervention (Acute Glucose Service, AGS) in two chronological groups; either perioperatively (AGS1) or also preoperatively (AGS2). The AGS-team provided diabetes education, identified the patients with diabetes risk and adjusted the medication when needed. Capillary plasma glucose (CPG) was repeatedly measured and glycated haemoglobin (HbA1c) obtained before and after the surgery. The study objectives were to evaluate the staff actions when hyperglycaemia was severe (CPG >10 mmol/L), and to assess improvement of the glycaemic values and the complication rate within 3 months.

Results: None of the severely hyperglycaemic events in the reference group were treated according to guidelines. In the AGS 1 group, 50% and in the AGS2 group, 53% were appropriately managed (p < .001). The events of hyperglycaemia (CPG >7.8 mmol/L at least twice) and of severe hyperglycaemia (CPG >10 mmol/L) decreased in all patient groups. The medians of the highest, mean and variability of CPG values improved. The mean HbA1c improved significantly within AGS 2. There was no association between improved glycaemic care and early complications.

Conclusions: AGS intervention significantly improves adherence to guidelines and glucose values.
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http://dx.doi.org/10.1111/aas.14012DOI Listing
March 2022

ABO and Rhesus Blood Groups in Acute Puumala Hantavirus Infection.

Viruses 2021 11 13;13(11). Epub 2021 Nov 13.

Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland.

Puumala hantavirus (PUUV) causes hemorrhagic fever with renal syndrome. We aimed to evaluate whether ABO and rhesus blood groups associate with the susceptibility or the severity of PUUV infection. We analyzed blood groups in 289 adult patients treated in Tampere University hospital due to PUUV infection during the years 1982-2017. Patients' blood group distribution was compared to that of healthy, voluntary blood donors living in the Tampere University Hospital responsibility area ( = 21,833). The severity of PUUV infection, as judged by the severity of acute kidney injury (AKI), thrombocytopenia, inflammation, capillary leakage, and the length of hospital care, was analyzed across the groups. The ABO and rhesus blood group distributions did not differ between the patients and blood donors. Patients with non-O blood groups had lower systolic blood pressure compared to patients with blood group O, but there was no difference in other markers of capillary leakage or in the severity of AKI. Minor deviations in the number of platelets and leukocytes were detected between the O and non-O blood groups. To conclude, patients with blood group O may be less susceptible to hypotension, but otherwise blood groups have no major influences on disease susceptibility or severity during acute PUUV infection.
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http://dx.doi.org/10.3390/v13112271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8621274PMC
November 2021
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