Bispebjerg Hospital, Copenhagen University
Recent publications
Aim Faecal calprotectin (FC) is a noninvasive marker that reflects intestinal inflammation with good sensitivity. A prior study indicated that FC values above 150 μg/g could distinguish between anal fistulas (AF) of cryptoglandular or Crohn's disease (CD) origin. It is hypothesized as a useful triage test to rule out CD in newly referred AF patients, thus reducing the number of ileocolonoscopies performed and optimizing treatment regimens in AF while minimizing patient discomfort as well as healthcare costs. The aim of the study was to determine the accuracy of FC in distinguishing between anal fistulas of cryptoglandular and CD origin, as well as compare characteristics in fistulas. Method Patients referred with anal fistula who had an FC measurement and either ileocolonoscopy or colonoscopy within 12 weeks were included. Demographic and clinical characteristics were registered. Area under the curve (AUC) was calculated as well as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy. Results A total of 63 patients were included (CD n = 31, 49%). FC was significantly higher in CD compared to cryptoglandular fistulas, even when CD was medically treated or had no luminal activity on endoscopy. FC ≥110 μg/g was significantly associated with CD (OR 12.5; 95% CI: 3.77–41.4) p < 0.0001. This was found by plotting a receiver operating characteristic (ROC) curve, with AUC 80.8 (95% CI: 0.6952–0.9217). Sensitivity and specificity were 0.76 and 0.80, respectively (PPV 76%, NPV 80% and accuracy 78%). Conclusion FC discriminates CD from cryptoglandular fistulas, even in medically treated CD with normal endoscopic findings.
BiCoVac is a population-based Danish cohort aiming to examine whether Coronavirus disease 2019 (COVID-19) vaccines are associated with non-specific symptoms beyond the specific protection of COVID-19. Data were collected by four questionnaire surveys between May 2021 and July 2022 and the questionnaire distribution was aligned with the Danish COVID-19 vaccination program. All surveys collected self-reported information on symptoms (e.g., headache, nausea, and fatigue). The baseline survey additionally gathered information on lifestyle and health. Survey data were combined with data from the Danish registers including information on COVID-19 vaccination and COVID-19 test results. A total of 911,613 (25% of all Danish citizens aged 16 to 65) were randomly sampled for the cohort and 252,401 initiated the baseline questionnaire. Of these, 59% (n = 149,070) participated in the 1st follow-up, 43% (n = 107,655) in the 2nd follow-up, and 25% (n = 63,737) in the 3rd follow-up. Women and individuals above 40 years of age were more likely to participate. Among vaccinated respondents, 25–38% reported moderate to severe immediate symptoms following COVID-19 vaccination, varying by vaccine doses. Females, younger individuals, and those with prior COVID-19 reported more immediate symptoms. Results of potential non-specific symptoms following COVID-19 vaccination did not reveal higher risk of involuntary movements among vaccinated individuals compared to unvaccinated individuals. Currently (December 2024), we are further investigating the effects of COVID-19 vaccines on other non-specific symptoms and exploring whether specific characteristics render some individuals more susceptible to report non-specific symptoms. In addition, long-term symptoms following COVID-19 are being investigated.
In the United States, 1 in 5 Americans develop keratinocyte carcinoma (KC) by age 70, placing the disease among the five most expensive cancers based on Medicare expenditure. Current preventative measures have failed to stem rising KC rates, highlighting the need for alternative strategies. Evolving evidence indicates that lasers conventionally used to treat photoaging, may provide protective effects against the development of KC and precursor lesion, actinic keratosis (AK). This review first delves into existing evidence on fractional infrared laser-based KC and AK prevention. Next, the work discusses potential underlying mechanisms that might explain fractional infrared lasers’ prophylactic effects. A comprehensive literature search of PubMed and Web of Science databases was conducted from inception to April 2024 using preselected search terms. Interventional human and animal studies, epidemiological analyses, and case reports on fractional infrared laser-based prevention of KC or AK were screened according to predefined inclusion/exclusion criteria. Included evidence demonstrates that ablative fractional lasers reduce and delay development of AK/KC, shown in two controlled trials of photodamaged patients and two murine studies (i.e. Er: YSGG and CO2 lasers). Weaker evidence of KC prevention by nonablative infrared lasers is provided by a retrospective cohort study. In the laser literature, three mechanisms are proposed to drive these prophylactic effects, including the ability of infrared lasers to (i) remove DNA-damaged epidermal cells, (ii) activate the insulin-like growth factor-1 pathway by reducing fibroblast senescence, and (iii) initiate immunomodulating effects. Based on current evidence, infrared fractional lasers show promise particularly for secondary KC prevention in photodamaged populations.
Several studies conducted during the last 50 years have shown that lower intelligence is associated with a higher body mass index (BMI). During this period, the prevalence of obesity and overweight has increased considerably. We investigated whether this increase has altered the relation between intelligence and BMI by studying two cohorts of 419,319 conscripts, born 1939–1959 and 1983–2001, examined in the same geographical districts in Denmark. While the prevalence of obesity increased from 0.8% in the early to 6.7% in the late cohort, the two cohorts showed essentially the same pattern of relations between intelligence test scores (ITS), prevalence of obesity and overweight (including obesity), and BMI. The prevalence of obesity and overweight and BMI was higher at any ITS value in the late than in the early cohort, but inversely associated with ITS in both cohorts. The ITS displayed inverse J-shaped associations with BMI, with ITS peaking around a BMI of 20 kg/m² and declining with higher BMI, although with a somewhat steeper decline in the early than in the late cohort. Thus, irrespective of the increase in prevalence of obesity and overweight and in BMI, the pattern of inverse relations between intelligence and higher BMI levels was maintained.
Real-world data on gender differences in quality of life among psoriasis patients before and during treatment are scarce. This study analysed data of 748 adults with moderate-to-severe psoriasis enrolled in the Swiss Dermatology Network of Targeted Therapy registry between 2011 and 2023. Quality of life was assessed using the Dermatological Life Quality Index at baseline and at 3, 6, 12, 18, and 24 months. At baseline, women reported significantly lower quality of life than men, with higher Dermatological Life Quality Index scores in the IL-17 inhibitor group (15.0 vs 11.0, p = 0.027), IL-12/23 inhibitor group (7.5 vs 7.0, p = 0.049), and non-biologic therapy group (13.0 vs 9.0, p < 0.001). Although quality of life improved across all subgroups during the follow-up period, women treated with IL-12/23 inhibitors continued to report worse quality of life compared with men after 2 years (p < 0.05), while no significant differences were observed with other therapies. These findings emphasize that women with psoriasis experience lower quality of life at treatment initiation and throughout non-biologic and biologic therapies, underlining the importance of addressing gender-specific differences in the management of psoriasis.
Purpose of Review This narrative review examines the potential implications of the expanded use of novel medications for obesity, particularly the GLP-1 receptor agonists, on weight stigma and societal attitudes towards pharmacologically induced weight loss. It analyses how these medications may potentially contribute to both reducing and exacerbating stigma and discusses strategies to reduce weight bias. Recent Findings The introduction of GLP-1 receptor agonists has demonstrated effectiveness in reducing weight and lead to improved health outcomes for individuals living with obesity. However, while these medications may reduce stigma by framing obesity as a medical issue rather than a personal failure, disparities in access and use related to high costs may inflate existing biases against those who cannot afford treatment. Also, a few studies indicate that users of these medications may feel stigmatised for taking what is perceived as an “easy way out” to lose weight, mirroring historical attitudes towards bariatric surgery. Summary The new medications for obesity may have the potential to reduce obesity stigma by reframing it as a medical condition rather than a moral failing. However, taking legal actions to build a more inclusive society including ensuring equitable access to these medications will be essential in mitigating stigma and help fostering a supportive environment for those living with obesity. Lessons from reducing stigma surrounding other medical conditions suggest that supportive health care and educational campaigns that promote the understanding of obesity as a complex health issue are needed to reshape negative perceptions towards individuals with obesity.
Background During rapid sequence induction, either rocuronium 1.0 mg kg ⁻¹ or suxamethonium 1.0 mg kg ⁻¹ can be administered to facilitate endotracheal intubation. We hypothezised that rocuronium provided a larger proportion of excellent intubating conditions compared to suxamethonium in elderly patients. Methods A total of 90 patients 80 years or above with American Society of Anesthesiologists physical health Classes I–IV, and a body mass index < 35 kg m ⁻¹⁻² were randomised to either rocuronium 1.0 mg kg ⁻¹ or suxamethonium 1.0 mg kg ⁻¹ during rapid sequence induction with intubation using a video laryngoscope. After 60 s, tracheal intubating conditions were evaluated using the Fuchs‐Buder scale by a blinded investigator, and the primary outcome was the proportion of patients with excellent intubating conditions. Further outcomes included first pass success rate, intubating conditions according to the intubating difficulty scale (IDS), onset time and postoperative occurrence of muscle soreness, hoarseness and sore throat. Results All patients were evaluated for the primary outcome. Excellent intubating conditions occurred in 36 patients (73%) versus 31 (75%) in the rocuronium group and suxamethonium group, respectively (95% confidence interval [CI]: −16 to 20) ( p = .82). The first pass success rate was 48 (98%) versus 40 (98%) comparing the rocuronium group with the suxamethonium group, respectively ( p = .90). No difference in IDS score was found; median 0 (interquartile ranges [IQR]: 0–1) versus median 0 (IQR: 0–1) ( p = .48). Onset time was significantly shorter in the suxamethonium group 99 versus 131 s ( p = .01) (95% CI: 7 to 57). Finally, no difference was found in the occurrence of muscle soreness, hoarseness or sore throat postoperatively. Conclusion No important difference in intubating conditions was found during rapid sequence induction after the administration of either rocuronium 1.0 mg kg ⁻¹ or suxamethonium 1.0 mg kg ⁻¹ in patients 80 years or above. Editorial Comment This reports a superiority trial comparing standardised doses of rocuronium and suxamethonium at 60 s for quality of intubating conditions in the rapid sequence context, and this in an elderly cohort. The findings showed no difference between the drugs concerning intubation outcomes, though the onset or time to peak effect was shorter for suxamethonium, again demonstrated in a cohort 80 years old or older.
19 Background: Neoadjuvant treatment with immune checkpoint inhibitors has shown remarkable responses in patients with deficient mismatch repair (dMMR) colorectal cancer. However, the optimal choice and duration of treatment have yet to be established. Methods: RESET-C (NCT05662527) was an investigator-initiated, phase II, single-arm, multicenter study investigating the efficacy and safety of single-cycle neoadjuvant pembrolizumab in 85 patients with resectable stage I-III dMMR colon cancer. Additional inclusion criteria were ≥ 18 years of age, no indication for neoadjuvant therapy, and Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1. After inclusion, patients received one cycle of pembrolizumab 4mg/kg (maximum 400mg) and underwent surgery within three to five weeks. A tumor-response evaluation was done before surgery, including blood samples, a computed tomography scan of the chest and abdomen, and a colonoscopy. The primary endpoint was the pathological complete response (pCR) rate according to Mandard tumor regression grading (Clopper-Pearson method). Secondary endpoints included surgical complications, safety of pembrolizumab, major pathological response (Mandard tumor regression grade 1 or 2), and disease-free survival. Results: Between February 2023 and March 2024, 85 patients were included. The median age was 74 years (IQR, 68-79), 72% were women, and 60% had clinical stage III disease. All patients received pembrolizumab, and 84 patients proceeded to surgery. One patient with stage I disease decided not to undergo surgery. A pCR rate of 44% (37/84; 95% CI, 33-55) and a major pathological response rate of 57% (48/84; 95% CI, 46-68) were found. A significantly higher pCR rate was seen in patients with stage I-II (20/33) versus stage III (17/51) disease (61% vs 33%; p=0.02). A total of 41 surgical complications were seen in 31 patients (37%; 95% CI, 27-48). Of these, eight complications were Clavien-Dindo grade 3a or above, including three patients with anastomotic leakages and two deaths within 30 days. The patients who died were aged 80 and 81, had ECOG performance status 1, and clinical stage IIIB and IIIC disease, respectively. Seven out of 85 patients (8%; 95% CI, 3-16) experienced grade 3 adverse events, three of which were treatment-related. No grade 4 or 5 adverse events were registered. Finally, data on the association between endoscopically evaluated clinical complete response and pCR, along with the 1-year disease-free survival rate expected in January 2025, will be reported. Conclusions: A single cycle of neoadjuvant pembrolizumab was efficacious and safe in patients with localized dMMR colon cancer. For most patients with clinical stage I-II disease, a single cycle sufficed to achieve pCR. Clinical trial information: NCT05662527 .
Background: Most patients with Cervical Artery Dissection (CeAD) have a good functional long-term (LT) outcome. Earlier studies suggest that outcomes are worse when psychological sequela and LT-quality of life (QoL) are considered. In CeAD-patients, we assessed LT-QoL, frequency of increased anxiety levels, post-traumatic stress disorder (PTSD, DSM-IV criteria), depression, fatigue, cognitive complaints and (ii)explored if baseline characteristics can identify patients at high risk of developing the aforementioned. Methods: LT-follow-up (LT-FU, ie >=12 months after baseline) study including consecutive CeAD patients treated at the University Hospital Basel (CH). Patients with excellent 3-month outcome (ie mRS 0-1) and no prior formal diagnosis of psychiatric disorder were eligible for inclusion. Patients were asked to answer pre-defined, established (eg HADS depression scale, SF-36, Checklist Individual Strength) questionnaires. Results: Data from 89 CeAD (56%, n=50 male) patients were analyzed. LT-FU was performed at a mean of 69.1 months (range 15-351 months) after baseline. At LT-FU, 36% (32/89) of participants reported feeling more anxious compared to before the CeAD. Threshold for formal diagnosis of anxiety was met by 14.6% (13/89) – ie 2x as high as the current global prevalence of anxiety in the general population. 11.2% of participants met the criteria for PTSD diagnosis – ie >5x the estimated 12-m-PTSD-prevalence in the general Swiss population. 19.1% (17/89) reported depression at any point between baseline and LT-FU, 48.3% (43/ 89), scored above thresholds for abnormal fatigue. Those who experienced heightened levels of anxiety experienced reduced QoL in 6/8 measured domains. Participants who met criteria for PTSD diagnosis scored lower on 4/8 QoL-domains. A higher degree of dissociation during index CeAD and a higher degree of cognitive complaints at LT-FU predicted heightened anxiety levels at LT-FU. Occlusion of the dissected artery, tinnitus at baseline and prior smoking predicted the presence of PTSD at LT-FU. Conclusion: CeAD patients seem to be at increased LT risk for anxiety, depression and PTSD compared to the background population. These mental health outcomes concur with a decrease in QoL. Severity of vascular pathology and dissociation during the index event might predict psychological sequlae in these patients. Further, prospective, ideally interventional studies investigating psychological sequela in CeAD patients are warranted.
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353 members
Peter-Martin Krarup
  • Department of Surgery
Pia Eiken
  • Department of Endocrinology and Gastroenterology
Søren Galatius
  • Department of Cardiology
Anne Frølich
  • Department of Integrated Care
Karen Aegidius
  • Department of Neurology
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Copenhagen, Denmark