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Olesen S.S.,University of Aalborg | Juel J.,University of Aalborg | Graversen C.,University of Aalborg | Graversen C.,University of Gottingen | And 4 more authors.
World Journal of Gastroenterology | Year: 2013

Intense abdominal pain is a prominent feature of chronic pancreatitis and its treatment remains a major clinical challenge. Basic studies of pancreatic nerves and experimental human pain research have provided evidence that pain processing is abnormal in these patients and in many cases resembles that seen in neuropathic and chronic pain disorders. An important ultimate outcome of such aberrant pain processing is that once the disease has advanced and the pathophysiological processes are firmly established, the generation of pain can become self-perpetuating and independent of the initial peripheral nociceptive drive. Consequently, the management of pain by traditional methods based on nociceptive deafferentation (e.g. surgery and visceral nerve blockade) becomes difficult and often ineffective. This novel and improved understanding of pain aetiology requires a paradigm shift in pain management of chronic pancreatitis. Modern mechanism based pain treatments taking into account altered pain processing are likely to increasingly replace invasive therapies targeting the nociceptive source, which should be reserved for special and carefully selected cases. In this review, we offer an overview of the current available pharmacological options for pain management in chronic pancreatitis. In addition, future options for pain management are discussed with special emphasis on personalized pain medicine and multidisciplinarity. © 2013 Baishideng Publishing Group Co., Limited. All rights reserved.


Metsna V.,East Tallinn Central Hospital | Metsna V.,University of Tartu | Vorobjov S.,National Institute for Health Development | Ma rtson A.,University of Tartu
Medicina (Lithuania) | Year: 2014

Background and objective:: Anterior knee pain (AKP) may compromise the results of total knee arthroplasty in more than quarter of cases. The aim of the current work was to determine the prevalence of AKP and the severity of patellofemoral symptoms among patients who received a total knee arthroplasty with non-replaced patella in East-Tallinn Central Hospital from January 1, 2000 to December 31, 2009. Materials and methods: We carried out a retrospective study involving 1778 consecutive total knee arthroplasties with non-replaced patella. Mean follow-up time was 68 months. We collected data by two patient-reported measures: the knee pain questionnaire and the Kujala score. Results: We diagnosed AKP among 20.2% of patients, 33.6% had pain in the knee from a source other than patellofemoral joint and 46.2% were pain free. In 87.3% of AKP cases the pain emerged within the first five years of knee replacement. AKP was more prevalent among patients with osteoarthritis compared to rheumatoid arthritis and among patients below 60 years. There was no difference in the prevalence of AKP in terms of gender or mobile and fixed bearing implants. The severity of patellofemoral symptoms in case of AKP was moderate. Conclusions: AKP is a frequent complication of total knee arthroplasty with non-replaced patella and patients undergoing this procedure should be apprised of the high probability of experiencing pain in the anterior part of the replaced knee. © 2014 Lithuanian University of Health Sciences.


Kuusik A.,Technology Competence Center | Reilent E.,Technology Competence Center | Loobas I.,Technology Competence Center | Parve M.,East Tallinn Central Hospital
Advances in Information Sciences and Service Sciences | Year: 2011

Results of several research groups indicate that modern home telehealth care systems should support patient personalization and context awareness. To deal with accompanying increase of data amount and processing complexity, a semantic reasoning approach is proposed. However, so far there are no practical, system level software architectures proposed to address all related issues within one complete solution. We describe a developed RDF blackboard based data processing solution for smart home telecare supporting off-the-self reasoning tools and existing ontologies.


Papp K.A.,Probity Medical Research | Langley R.G.,Dalhousie University | Sigurgeirsson B.,University of Iceland | Abe M.,Gunma University | And 6 more authors.
British Journal of Dermatology | Year: 2013

Background Conventional systemic therapies for plaque psoriasis have not fully met the needs of patients, and although current biologic treatments are generally well tolerated, concerns exist with respect to long-term safety. Interleukin (IL)-17A is believed to be an important effector cytokine in the pathogenesis of psoriasis and is produced by Th17 cells, a class of helper T cells that act outside the established Th1/Th2 paradigm for regulation of innate and adaptive immunity. Objectives To assess the efficacy and safety of different doses of secukinumab, a fully human anti-IL-17A IgG1κ monoclonal antibody, in patients with moderate-to-severe plaque psoriasis. Methods Patients (n = 125) were randomized 1: 1: 1: 1: 1 to receive subcutaneous doses of placebo (n = 22) or secukinumab [1 × 25 mg (n = 29), 3 × 25 mg (n = 26), 3 × 75 mg (n = 21) or 3 × 150 mg (n = 27)] at weeks 0, 4 and 8. After the 12-week treatment period, patients entered a follow-up period of 24 weeks. The primary efficacy outcome was at least 75% improvement from baseline in the Psoriasis Area and Severity Index score (PASI 75); secondary outcomes included the Investigator's Global Assessment (IGA) and PASI 90 and 50 response rates. Results After 12 weeks of treatment, secukinumab 3 × 150 mg and 3 × 75 mg resulted in significantly higher PASI 75 response rates vs. placebo (82% and 57% vs. 9%; P < 0·001 and P = 0·002, respectively). Higher PASI 75 response rates compared with placebo were maintained throughout the follow-up period with these dosages [week 36, 26% (n = 7) and 19% (n = 4) vs. 4% (n = 1), respectively], with a gradual decline of PASI 75 response over time after the dosing period. IGA response rates were significantly higher in the 3 × 150 mg group vs. placebo at week 12 (48% vs. 9%; P = 0·005) and were consistently higher for the 3 × 150 mg and 3 × 75 mg groups vs. placebo at all time points from week 4 onward. The PASI 90 response rate was significantly higher in the 3 × 150 mg group vs. placebo (52% vs. 5%) at week 12 and remained higher during the follow-up period. Secukinumab was well tolerated. Two cases of neutropenia (≤ grade 2) were reported in the 3 × 150 mg cohort. Conclusions Treatment with subcutaneous secukinumab 3 × 75 mg and 3 × 150 mg met the primary outcome of PASI 75 response achievement after 12 weeks, demonstrating efficacy in moderate-to-severe psoriasis. © 2012 The Authors. BJD © 2012 British Association of Dermatologists.


Metsna V.,University of Tartu | Metsna V.,East Tallinn Central Hospital | Vorobjov S.,National Institute for Health Development | Lepik K.,East Tallinn Central Hospital | Martson A.,University of Tartu
Acta Orthopaedica | Year: 2014

Background - Attempts to relate patellar cartilage involvement to anterior knee pain (AKP) have yielded conflicting results. We determined whether the condition of the cartilage of the patella at the time of knee replacement, as assessed by the OARSI score, correlates with postsurgical AKP. Patients and methods - We prospectively studied 100 patients undergoing knee arthroplasty. At surgery, we photographed and biopsied the articular surface of the patella, leaving the patella unresurfaced. Following determination of the microscopic grade of the patellar cartilage lesion and the stage by analyzing the intraoperative photographs, we calculated the OARSI score. We interviewed the patients 1 year after knee arthroplasty using the HSS patella score for diagnosis of AKP. Results - 57 of 95 patients examined had AKP. The average OARSI score of painless patients was 13 (6-20) and that of patients with AKP was 15 (6-20) (p = 0.04). Patients with OARSI scores of 13-24 had 50% higher risk of AKP (prevalence ratio = 1.5, 95% CI: 1.0-2.3) than patients with OARSI scores of 0-12. Interpretation - The depth and extent of the cartilage lesion of the knee-cap should be considered when deciding between the various options for treatment of the patella during knee replacement. © Copyright: Nordic Orthopaedic Federation.


Kuusik A.,Competence Center | Nomm S.,Tallinn University of Technology | Ovsjanski S.,Tallinn University of Technology | Orunurm L.,East Tallinn Central Hospital | Reilent E.,Competence Center
IEEE EMBS Special Topic Conference on Point-of-Care (POC) Healthcare Technologies: Synergy Towards Better Global Healthcare, PHT 2013 | Year: 2013

In this paper we describe an extendable point of care system for simultaneous motor rehabilitation (post-stroke and -arthroscopy) patient condition assessment and patient safety observations. Electronic linear and angular accelerometer sensors attached to the human upper or lower limbs gather information about performed therapeutic exercises. The measurement data processing of the vital sign sensors and accelerometers is done in the health hub device in real time with the patient feedback. The movement correctness evaluation and gait analysis is done with ANARX neural network based models. The system is implemented and tested. The evaluation of the test results is presented. © 2013 IEEE.


Kolesnikov Y.,East Tallinn Central Hospital | Gabovits B.,East Tallinn Central Hospital | Levin A.,East Tallinn Central Hospital | Voiko E.,East Tallinn Central Hospital | Veske A.,Tallinn University of Technology
Anesthesia and Analgesia | Year: 2011

BACKGROUND: Previous studies have generated controversial results regarding the influence of the genetic variations of μ-opioid receptors on morphine analgesia and opioid-related side effects in the postoperative period. Few studies have been conducted attempting to assess the combined effects of variation within ≥2 genes in relation to morphine response. In this study, we investigated whether combined catechol-O-methyltransferase and μ-opioid receptor polymorphisms contribute to the morphine response in postoperative analgesia. METHODS: One hundred two surgical patients were enrolled in this prospective, observational study. All patients received general anesthesia and were screened for μ-opioid receptor polymorphism A118G (Asn40Asp) and catechol-O-methyltransferase G1947A (Val158Met) polymorphism using a blood sample of DNA. Patient-controlled analgesia was provided postoperatively and morphine consumption was observed. Any pain at rest or side effects were measured with rating scales. RESULTS: The heterozygous patients with μ-opioid receptor A118G and catechol-O-methyltransferase G1947A mutation consumed significantly less morphine in the postanesthetic recovery room and 48 hours after surgery compared with homozygous patients of the A118 variant. Nausea and sedation scores were also significantly lower during all observed postoperative periods for heterozygous patients and only 2 patients (18%) from this group received antinausea treatment. CONCLUSION: This study has demonstrated the importance of the gene-gene approach in understanding the morphine response in patients after lower abdominal surgery. More studies are needed to characterize the combined effects of multiple genes and demographic as well as clinical variables in predicting the correct morphine dosage and corresponding opioid-related side effects. Copyright © 2011 International Anesthesia Research Society.


Laks T.,North Estonia Medical Center | Joeste E.,Institute of Clinical Medicine | Pullisaar O.,North Estonia Medical Center | Maeots E.,East Tallinn Central Hospital | And 3 more authors.
Annals of Medicine | Year: 2013

Objectives. Coronary event rates have declined in most Western countries during the past decades, but the trends in the former Eastern block have not been established. The purpose of the present study was to examine the trends in acute coronary events during 1991-2005 in Tallinn, Estonia. Design. The Tallinn Acute Myocardial Infarction (AMI) Registry recorded all AMI events among the residents of Tallinn, Estonia, aged 35-64 years during two time periods, 1991-1997 and 2003-2005. Results. Altogether, 4889 AMI events were recorded. The average age-standardized incidence and attack rate of AMI events were lower in the second than in the first registration period in both sexes. When analyzed annually, the AMI event rates increased from 1991 to 1993 in both sexes. Thereafter from 1993 to 2005 the incidence of first AMI events declined significantly, 2.7%/year in men and 5.0%/year in women (P < 0.001 for both). Also the other event types, except the attack rate among men, tended to decline after 1993. Conclusions. The year 1993 denoted a significant turning-point in the trends in AMI events in Tallinn, Estonia. After that especially the incidence of first AMI started to decline, and the declines have continued until 2005. © 2013 Informa UK, Ltd.


Uuskula A.,University of Tartu | Muursepp A.,Merck And Co. | Kawai K.,Temple University | Raag M.,University of Tartu | And 2 more authors.
BMC Infectious Diseases | Year: 2013

Background: This analysis assessed the epidemiological and economic impact of quadrivalent human papillomavirus (HPV4: 6/11/16/18) vaccination in Estonia.Methods: A dynamic transmission model was used to assess the epidemiological and economic impact of the routine vaccination of 12-year-old girls with a HPV4 vaccine in preventing cervical cancer, cervical intraepithelial neoplasia (CIN) grades 1, 2 and 3 and genital warts.Results: The model projected that at year 100, HPV4 vaccination would lead to a reduction of HPV 16/18 related cervical cancer incidence and deaths by over 97% and the incidence of HPV 6/11 related genital warts among Estonian women and men by over 94% and 81%, respectively. The incremental cost-effectiveness ratio of the HPV4 vaccination strategy was € 4,889 per QALY gained over a time horizon of 100 years.Conclusions: Routine vaccination of 12-year-old girls with HPV4 vaccine appears to be cost-effective in Estonia, in addition to providing both short term and long term health gains. © 2013 Uusküla et al.; licensee BioMed Central Ltd.


Aaviksoo E.,University of Tartu | Aaviksoo E.,East Tallinn Central Hospital | Baburin A.,39 Health | Kiivet R.-A.,University of Tartu
Occupational Medicine | Year: 2013

Background: During the last decade, sickness absence rates in Estonia have reached the level of Nordic countries. This places Estonia in a group of countries with the highest absence rate in the European Union. Unlike Nordic countries, factors associated with sickness absence have not been studied in Estonia. Aims: To investigate which work-related, individual and health factors, other than current illness, influence sickness absence among Estonian paid employees. Methods: The study population consisted of 2941 employees who completed an Estonian Health Interview Survey conducted in 2006. Multiple logistic regression analysis was performed to explore associations between individual, health and work-related factors and recent sickness absence. Results: Sickness absence was significantly associated with poor self-rated general health (OR = 1.82; 95% CI = 1.34-2.48), presence of chronic disease (OR = 1.66; 95% CI = 1.21-2.27), lower education (OR = 1.59; 95% CI = 1.20-2.12) and job dissatisfaction (OR = 1.74, 95% CI = 1.23-2.26) in the final multivariate model after adjustment for age and gender Conclusions: Most sickness absence risk factors revealed by previous studies were only moderately associated with sickness absence in the Estonian working population. In contrast to Nordic countries, there was no gender difference or age gradient. Among workplace risk factors, job dissatisfaction was most strongly associated with sickness absence. © The Author 2012. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved.

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