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Herning, Denmark

Lauszus F.F.,Herning Hospital
Current Hypertension Reviews

The most recent Cochrane reviews on oral antihypertensive drugs in pregnancy conclude that no substantial benefits for the mother or fetus are demonstrated so far. Whether this applies for a high-risk and diabetic pregnancy is doubtful. The aim of this short review is an introduction to the field of ambulatory blood pressure measurements in pregnancy and in particular in women with type 1 diabetes. Diabetic pregnancy is complicated with a 50% risk of hypertension/preeclampsia. In the nonpregnant, diabetic women minute increases in blood pressure as well as in albuminuria are forerunners for incipient and overt nephropathy. Medication is essential and can conserve renal function, modifying the risk of renal insufficiency. During pregnancy, renal insufficiency in women with diabetes leads to termination of pregnancy. Therefore, detection of minute changes based on reliable measurements in this high-risk population is invaluable to protect the mother’s kidney function and, if possible, prolong pregnancy for the benefit of the fetus. Estimates of risk by blood pressure evaluation in these women are influenced by pregnancy per se and diabetes vasculopathy. Several factors have to be considered as few monitors are validated for use in pregnancy and not many of the different methodologies have undergone thorough investigation. The use of absolute values of blood pressure have the advantage that fewer assumptions are necessary on how blood pressure behaves due to modes of evaluation and biological rhythm. Monitors should be chosen with care considering the clinical setting, timing, and population, which influences the outcome, thus, the monitors ought to be validated for the specific condition they are applied for. The strategy for the studies used for safe conclusions in this brief review was chosen with priority of the papers with the best, validated methodology on BP measurements, which is by no way guaranteed in numerous recent publications. Inherent characteristics of the measurements to be considered are reproducibility, consistency, precision, and trend over scale of measurement. Studies on these issues suggest that consistency and precision depend on which monitor is used. During pregnancy, the reproducibility and specificity depend on the timing and whether measurements are performed repeatedly. Over- and underestimations of blood pressure are typical for 24-h monitoring in high- as well as low risk pregnancies. Preeclampsia is associated with urinary albumin excretion rate, reduced night/day ratio, and elevated diurnal blood pressure from first trimester and onwards. However, due to blunting of the diurnal variation, the night/day rhythm provides no good prediction of preeclampsia. Diurnal measurement is a valuable estimate of blood pressure in terms of sensitivity, specificity, and predictive values. © 2016 Bentham Science Publishers. Source

Perner A.,Copenhagen University | Haase N.,Copenhagen University | Guttormsen A.B.,University of Bergen | Tenhunen J.,University of Tampere | And 29 more authors.
New England Journal of Medicine

BACKGROUND: Hydroxyethyl starch (HES) 130/0.42 is widely used for fluid resuscitation in intensive care units (ICUs), but its safety and efficacy have not been established in patients with severe sepsis. METHODS: In this multicenter, parallel-group, blinded trial, we randomly assigned patients with severe sepsis to fluid resuscitation in the ICU with either 6% HES 130/0.42 (Tetraspan) or Ringer's acetate at a dose of up to 33 ml per kilogram of ideal body weight per day. The primary outcome measure was either death or end-stage kidney failure (dependence on dialysis) at 90 days after randomization. RESULTS Of the 804 patients who underwent randomization, 798 were included in the modified intention-to-treat population. The two intervention groups had similar baseline characteristics. At 90 days after randomization, 201 of 398 patients (51%) assigned to HES 130/0.42 had died, as compared with 172 of 400 patients (43%) assigned to Ringer's acetate (relative risk, 1.17; 95% confidence interval [CI], 1.01 to 1.36; P = 0.03); 1 patient in each group had end-stage kidney failure. In the 90-day period, 87 patients (22%) assigned to HES 130/0.42 were treated with renal-replacement therapy versus 65 patients (16%) assigned to Ringer's acetate (relative risk, 1.35; 95% CI, 1.01 to 1.80; P = 0.04), and 38 patients (10%) and 25 patients (6%), respectively, had severe bleeding (relative risk, 1.52; 95% CI, 0.94 to 2.48; P = 0.09). The results were supported by multivariate analyses, with adjustment for known risk factors for death or acute kidney injury at baseline. CONCLUSIONS: Patients with severe sepsis assigned to fluid resuscitation with HES 130/0.42 had an increased risk of death at day 90 and were more likely to require renal-replacement therapy, as compared with those receiving Ringer's acetate. (Funded by the Danish Research Council and others; 6S ClinicalTrials.gov number, NCT00962156.) Copyright © 2012 Massachusetts Medical Society. Source

Arendrup M.C.,Statens Serum Institute | Dzajic E.,Sydvestjysk Sygehus | Jensen R.H.,Statens Serum Institute | Johansen H.K.,Copenhagen University | And 10 more authors.
Clinical Microbiology and Infection

Significant changes in the management of fungaemia have occurred over the last decade with increased use of fluconazole prophylaxis, of empirical treatment and of echinocandins as first-line agents for documented disease. These changes may impact the epidemiology of fungaemia. We present nationwide data for Denmark from 2010 to 2011. A total of 1081 isolates from 1047 episodes were recorded in 995 patients. The numbers of patients, episodes and recovered isolates increased by 13.1%, 14.5% and 14.1%, respectively, from 2010 to 2011. The incidence rate was significantly higher in 2011 (10.05/100 000) than in 2010 (8.82/100 000), but remained constant in the age groups 0-79 years. The incidence rate was highest at the extremes of age and in males. Candida albicans accounted for 52.1% but declined during 2004-11 (p 0.0155). Candida glabrata accounted for 28% and increased during 2004-2011 (p <0.0001). Candida krusei, Candida tropicalis and Candida parapsilosis remained rare (3.3-4.2%). The species distribution changed with increasing age (fewer C. parapsilosis and more C. glabrata) and by study centre. Overall, the susceptibility rates were: amphotericin B 97.3%, anidulafungin 93.8%, fluconazole 66.7%, itraconazole 69.6%, posaconazole 64.2% and voriconazole 85.0%. Acquired echinocandin resistance was molecularly confirmed in three isolates. The use of systemic antifungals doubled over the last decade (2002-2011) (from 717 000 to 1 450 000 defined daily doses/year) of which the vast majority (96.9%) were azoles. The incidence of fungaemia continues to increase in Denmark and is associated with a decreasing proportion being susceptible to fluconazole. Changes in demography, higher incidence in the elderly and higher antifungal consumption can at least in part explain the changes. © 2013 European Society of Clinical Microbiology and Infectious Diseases. Source

Wittbrodt P.,Herning Hospital | Haase N.,Rigshospitalet | Butowska D.,Copenhagen University | Winding R.,Herning Hospital | Poulsen J.B.,Rigshospitalet
Critical Care

Introduction: The effects of hydroxyethyl starch (HES) on patient-centered outcome measures have not been fully described in patients with severe sepsis. We assessed health-related quality of life (HRQoL) and the occurrence of pruritus in patients with severe sepsis randomized to resuscitation with HES 130/0.42 or Ringer's acetate.Methods: We did post hoc analyses of the Danish survivors (n = 295) of the 6S trial using mailed questionnaires on self-perceived HRQoL (Short Form (SF) - 36) and pruritus.Results: Median 14 months (interquartile range 10 to 18) after randomization, 182 (61%) and 185 (62%) completed questionnaires were obtained for the assessment of HRQoL and pruritus, respectively. Responders were older than nonresponders, but characteristics at randomization of the responders in the HES vs. Ringer's groups were comparable. At follow-up, the patients in the HES group had lower mental component summary scores than those in the Ringer's group (median 45 (interquartile range 36 to 55) vs. 53 (39 to 60), P = 0.01). The group differences were mainly in the scales of vitality and mental health. There was no difference in the physical component summary scores between groups, but patients in the HES group scored worse in bodily pain. Forty-nine percent of patients allocated to HES had experienced pruritus at any time after ICU discharge compared to 43% of those allocated to Ringer's (relative risk 1.13, 95% confidence interval 0.83 to 1.55, P = 0.43).Conclusions: At long-term follow-up patients with severe sepsis assigned to resuscitation with HES 130/0.42 had worse self-perceived HRQoL than those assigned to Ringer's acetate whereas there were no statistically significant differences in the occurrence of pruritus. © 2013 Wittbrodt et al.; licensee BioMed Central Ltd. Source

Lauszus F.F.,Herning Hospital | Fuglsang J.,Aarhus University Hospital
Gynecological Endocrinology

Aim: No data on IGF-1 and either preterm or preeclampsia have been reported so far in diabetic pregnancies. We evaluated consecutive measurements of IGF-1 for preeclampsia, preterm delivery and birth weight in type 1 diabetic pregnancy. Setting: In an outpatient university clinic, 97 pregnant women were consecutively recruited for evaluation of indicators for deterioration of diabetes status and adverse perinatal outcome. At every visit, a blood sample for measurement of IGF-1 was drawn. Results: IGF-1 levels from week 14 to 32 was consistently lower in women who delivered preterm compared with women whose delivered after gestational week 36; the increase in 2nd and 3rd trimester was steeper in those delivering at term than in women delivering preterm (p = 0.032). IGF-1 in preeclampsia did not show the same relation in diabetic women (p = 0.74). The lowest tertile of birth weight ratio (0.8–1.2) was associated with lower IGF-1 from week 14 to 32 (p = 0.047, adjusted for preterm delivery and preeclampsia). Conclusion: We found low IGF-1 levels associated with preterm delivery and low birth weight. © 2016 Taylor & Francis. Source

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