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Biomedical subjects

L Lind

Publications and source records attributed to L Lind.

At least 19 recordsLinked to original sources
PubMed1997

Efficacy of a monocomponent pertussis toxoid vaccine after household exposure to pertussis.

In a double-blind, placebo-controlled efficacy trial of a monocomponent pertussis toxoid vaccine, 3450 infants were randomly assigned to vaccination with diphtheria-tetanus toxoids with or without pertussis toxoid at 3, 5, and 12 months of age. Study children and family members were investigated for possible pertussis with cultures, serology, and polymerase chain reaction. Efficacy was 71% after 3 dose when the World Health Organization case definition of pertussis (which includes paroxysmal cough for 21 days or longer) was used. We report the efficacy in the subgroup of children who were exposed to pertussis in the household. Among study children exposed to pertussis in the household from the day of the third vaccination, 20 of 99 (20%) recipients of diphtheria-tetanus-pertussis toxoids vaccine and 64 of 79 (81%) recipients of diphtheria-tetanus toxoids vaccine had pertussis fulfilling criteria of the World Health Organization. The vaccine efficacy was 75% (95% confidence intervals 64% to 84%). In children who had received only two doses at the time of household exposure, vaccine efficacy was 66% (95% confidence intervals 15% to 90%) based on 4 cases among 32 household-exposed recipients of diphtheria-tetanus-pertussis toxoids vaccine and 13 cases among 35 household-exposed recipients of diphtheria-tetanus toxoids vaccine. In conclusion, the pertussis toxoid vaccine provides protection against pertussis both after household and community exposure.

Diphtheria Toxoid↗
PubMed1997

The alterations in insulin sensitivity during angiotensin converting enzyme inhibitor treatment are related to changes in the calcium/magnesium balance.

The present analysis was undertaken to investigate the relations between alterations in mineral factors, especially the balance between serum calcium and magnesium concentrations (S-Ca and S-Mg, respectively), and variables reflecting glucose and lipid metabolism during angiotensin converting enzyme (ACE) inhibitor treatment. A total of 96 patients with essential hypertension, participating in four double-blind studies with four different ACE inhibitors and similar protocols, were included. At the end of the initial placebo period and at the end of the period of active drug treatment, a hyperinsulinemic euglycemic clamp test was carried out, lipoprotein status was assessed, and the concentrations of serum electrolytes were measured. The serum ACE activity was determined in the group treated with fosinopril. Changes in insulin sensitivity index (M/I) were directly correlated to alterations in S-Mg (r = 0.24, P < .02), and inversely correlated to changes in S-Ca (r = -0.19, P = .07) and the ratio between serum calcium and magnesium concentrations (Ca/Mg) (r = -0.27, P < .008). The change in total serum triglycerides (S-Tg) was inversely correlated to the change in S-Mg (r = -0.35, P < .0005), and directly correlated to the change in Ca/Mg ratio (r = 0.36, P < .0004). The reduction in serum ACE activity correlated to a more pronounced increase in S-Mg r = -0.62, P < .002), and decrease in the Ca/Mg ratio (r = 0.73, P = .0002). We conclude that the changes in the studied metabolic variables and serum ACE activity during ACE inhibitor treatment are related to alterations in mineral status and the balance between calcium and magnesium concentrations in serum.

Adolescent↗
PubMed1997

Cardiovascular risk factors and electrographical characteristics and abnormalities in middle-aged males.

OBJECTIVES: To evaluate if characteristics and abnormalities found at the electrocardiogram (ECG) are related to common cardiovascular risk factors included in the insulin-resistance metabolic syndrome. DESIGN: Cross-sectional. SETTING: Tertiary university hospital. SUBJECTS: Over 2000 middle-aged males in whom ECG abnormalities were recorded, together with ECG characteristics measured in a random sample of men with no ECG abnormalities (n = 113). INTERVENTIONS: None. RESULTS: All three components of the metabolic syndrome; elevated blood pressure, dyslipidaemia and hyperinsulinaemia were found to be related to the heart rate (P < 0.002) and the QRS-duration (P < 0.01) and inversely to the QoT-interval (P < 0.05), the early diastolic phase (P < 0.05) and the T-wave amplitude (P < 0.02). The components of the metabolic syndrome was furthermore found to be associated with the occurrence of T-wave abnormalities (n = 64, P < 0.01) and to a lesser degree also to the occurrence of Q-waves (n = 21). CONCLUSIONS: The components of the insulin-resistance metabolic syndrome were related both to certain ECG characteristics in subjects with a normal ECG and to some ECG abnormalities. A raised sympathetic activity is likely to be the link between some of the described associations, whilst coronary heart diseases may explain others.

Blood Pressure↗
PubMed1997

Unchanged efficacy of a pertussis toxoid vaccine throughout the two years after the third vaccination of infants.

BACKGROUND: In a previously reported double blind efficacy trial of a pertussis toxoid vaccine, 3450 infants were randomized to receive diphtheria-tetanus toxoids with or without pertussis toxoid at 3, 5 and 12 months of age. Efficacy against pertussis as defined by the World Health Organization was 71% from 30 days after the third vaccination with an average follow-up of 17.5 months. We now report efficacy for an additional 6 months of open follow-up. METHODS: Parents were contacted monthly by a nurse. If a participant or a family member coughed for > or = 7 days, a nasopharyngeal sample and paired sera were obtained. RESULTS: Efficacy during this open follow-up period was 77% (95% confidence intervals, 66 to 85%) based on 29 and 110 cases fulfilling the WHO definition of pertussis in vaccinated and control children, respectively. Efficacy against household exposure was 76% (95% confidence intervals, 51 to 91%). Pertussis in vaccinated children had a significantly shorter duration than pertussis in control children. Determination of pertussis toxin antibodies in paired sera with enzyme-linked immunosorbent assay had a lower diagnostic sensitivity in vaccinated (45%) than in control (92%) children, while determination of antibodies against filamentous hemagglutinin (not included in the vaccine) was highly sensitive for diagnosing pertussis in both groups (100 and 90%, respectively). CONCLUSIONS: A monocomponent pertussis toxoid vaccine induces significant protection against pertussis for at least 2 years after the third injection. To obtain an unbiased estimate of vaccine efficacy it is important to determine antibodies against an antigen that is not included in the vaccine.

Antibodies, Bacterial↗
PubMed1996

Relationship between diastolic hypertension and myocardial morphology and function in elderly males with diabetes mellitus.

The existence of a distinct diabetic cardiomyopathy, characterized by a raised left ventricular mass, has previously been suggested. However, as diabetes mellitus is associated with both left ventricular hypertrophy and hypertension a confounding effect of raised blood pressure in diabetic patients has to be considered. In the present cross-sectional study an echocardiographical examination was performed as part of a health screening survey in 582 males, aged 70 years. After the exclusion of subjects with coronary heart disease or those on regular antihypertensive treatment, 30 normotensive subjects with diabetes were compared with 10 subjects with non-insulin-dependent diabetes (NIDDM) and a diastolic blood pressure 90 mm Hg or more and 203 normotensive control subjects with normal glucose tolerance. Both groups with NIDDM showed a significantly increased left atrial diameter (4.4 +/- 0.7 vs 4.0 +/- 0.5 cm, p < 0.05) and an increased atrial component in diastole (A-wave, p < 0.01) compared to the control subjects. Left ventricular mass was, however, only marginally and not significantly elevated in the diabetic subjects when compared to the healthy control subjects (133 +/- 19 and 133 +/- 28 vs 128 +/- 25 g/m2). Only in the subjects with concomitant diabetes and a raised blood pressure was the intraventricular septum significantly enlarged (p < 0.05). Thus, in the present sample no distinct diabetic cardiomyopathy with an increased left ventricular mass, independent of the influence of hypertension could be detected. The myocardial alterations in these diabetic males were restricted to an increased left atrial size and an impaired diastolic function.

Aged↗
PubMed1996

The blood pressure response to antihypertensive treatment with lisinopril or bendrofluazide is related to the calcium and magnesium contents in skeletal muscle.

To evaluate the association between skeletal muscle mineral balance and effect of antihypertensive treatment, 37 patients with essential hypertension, randomly treated with either lisinopril or bendrofluazide, were investigated with skeletal muscle biopsies before and after 6 months of treatment. The ratio between calcium and magnesium concentrations in skeletal muscle prior to treatment predicted the blood pressure response during active treatment (r = -0.38, P < .02). During treatment the change in blood pressure was related to the change in muscle Ca/Mg ratio (r = 0.35, P < .05), especially in the patients treated with lisinopril. Thus, an association between the calcium and magnesium balance in skeletal muscle and the blood pressure response to antihypertensive treatment was found in the present study.

Analysis of Variance↗
PubMed1996

Left ventricular hypertrophy and geometry in a population sample of elderly males.

BACKGROUND: Recent studies have shown that left ventricular geometric adaptation to hypertension is complex. The spectrum of geometric adaptations in a general population and its relationship to systolic and diastolic function has, however, not been investigated. OBJECTIVES AND METHODS: This echocardiographic and Doppler study investigated the relationships between left ventricular geometric shape (normal, concentric remodelling, concentric hypertrophy and eccentric hypertrophy) and left ventricular systolic and diastolic function in a population sample of 584 males aged 70 in Uppsala, Sweden. The influences of hypertension, coronary heart disease and diabetes mellitus were also evaluated. RESULTS: Sixteen percent of the healthy population (n = 167) demonstrated the presence of left ventricular hypertrophy (mainly eccentric). Subjects with hypertension (n = 115) showed an increased left ventricular mass (eccentric left ventricular hypertrophy 31%, concentric left ventricular hypertrophy 15%), when compared with healthy subjects (P < 0.001). Subjects with coronary heart disease (n = 32) without hypertension also showed an increased left ventricular mass (most often eccentric) (P < 0.05). Using Doppler determinations of cardiac index, no differences were found in cardiac index between the geometric groups. Raised total peripheral resistance, increased blood pressure and enlarged left atrium were found in both concentric and eccentric left ventricular hypertrophy (P < 0.01-0.05). Disturbed diastolic function was seen with a prolongation of the isovolumic relaxation time in eccentric (P < 0.01) and increased atrial-dependent left ventricular filling in concentric left ventricular hypertrophy (P < 0.05). CONCLUSION: Alterations in left ventricular geometry were common in this population-based study of elderly males, both in healthy subjects and in subjects with hypertension or coronary heart disease. Raised total peripheral resistance and left ventricular diastolic dysfunction were common findings in both concentric and eccentric left ventricular hypertrophy.

Aged↗
PubMed1996

DNA fingerprinting and serotyping of Campylobacter jejuni isolates from epidemic outbreaks.

The aim of the present investigation was to compare DNA fingerprinting and serotyping (heat-stabile and heat-labile antigens) of isolates from epidemic outbreaks as well as of solitary isolates. Campylobacter jejuni isolates from two epidemic outbreaks in Sweden, one milkborne (35 isolates) and one waterborne (17 isolates), and one waterborne outbreak in Norway (11 isolates), as well as 30 solitary isolates from Swedish patients with gastroenteritis, were analyzed. A total of 93 isolates were analyzed. In the waterborne outbreak in Norway, only one serotype with one DNA pattern was found. In the milkborne outbreak in Sweden, two serotypes (HS2:HL4 and HSNT:HL4) with two different DNA patterns were found. The isolates from the waterborne outbreak in Sweden were different serotypes. For two isolates of the same serotype, different DNA patterns were seen. This was also recorded for isolates from solitary cases. It was concluded that serotyping is a useful tool in most epidemiological situations but sometimes lacks sufficient discriminatory power. DNA fingerprinting can add valuable epidemiological information to that supplied by serotyping and can in some situations provide sufficient epidemiological information when used alone.

Animals↗
PubMed1995

A placebo-controlled trial of a pertussis-toxoid vaccine.

BACKGROUND: Although many whole-cell vaccines have been effective in preventing pertussis, these vaccines are difficult to standardize and can produce side effects. In Sweden, pertussis became endemic during the 1970s despite vaccination. Because of its limited efficacy, the Swedish-made whole-cell vaccine was withdrawn in 1979. METHODS: To evaluate the efficacy of an acellular vaccine consisting of pertussis toxin inactivated by hydrogen peroxide (pertussis toxoid), we conducted a randomized, double-blind, placebo-controlled trial in Sweden. Infants were vaccinated with either diphtheria and tetanus toxoids alone (DT toxoids, 1726 infants) or diphtheria, tetanus, and pertussis toxoids (DTP toxoids, 1724 infants) at 3, 5, and 12 months of age. RESULTS: There were no serious reactions. With the pertussis vaccine there were slightly more local reactions than with the DT toxoids alone, but the rates of postvaccination fever were the same. The main period of surveillance, which began 30 days after the third vaccination, continued for a median of 17.5 months. There were 312 cases of pertussis (72 in the DTP-toxoids group and 240 in the DT-toxoids group) that met the clinical criterion (paroxysmal cough lasting > or = 21 days) and laboratory criteria for pertussis as defined by the World Health Organization. The efficacy of this acellular vaccine was 71 percent (95 percent confidence interval, 63 to 78 percent). The recipients of DTP toxoids who had pertussis had cough of shorter duration than the recipients of DT toxoids, and fewer had whooping and vomiting. The vaccine efficacy after two doses was 55 percent (95 percent confidence interval, 12 to 78 percent), on the basis of 14 cases in the DTP-toxoids group and 31 in the DT-toxoids group that met the definition of the World Health Organization. CONCLUSIONS: A pharmacologically inert, acellular pertussis-toxoid vaccine that is easily standardized is safe and confers substantial protection against pertussis.

Diphtheria Toxoid↗
PubMed1995

Pronounced elevation in circulating calcitonin in critical care patients is related to the severity of illness and survival.

OBJECTIVE: To study circulating levels of calcitonin in critically ill patients in relation to the severity of illness and survival. DESIGN: Cross-sectional and prospective. SETTING: The ICU in Gävle hospital, a secondary non-teaching hospital. PATIENTS: 37 consecutive ICU patients. MEASUREMENTS AND RESULTS: Serum calcium and immunoreactive calcitonin (iCT) were measured and the Apache II and the Multiple Organ Failure (MOF) scores were recorded during the first 24 h in the ICU. Patients were followed for hospital survival. Profound increase in circulating iCT was seen (mean 591, median 184, range 8-3445 pg/ml) in the studied sample and only 11% of the patients showed normal levels (< 40 pg/ml). iCT was higher in septic than nonseptic patients (p < 0.004) and was correlated to two indices of severity of illness (r = 0.50, p < 0.006 versus the Apache II score and p = 0.55, p < 0.003 versus the MOF score). Furthermore, iCT was correlated to the length of stay in the intensive care unit (r = 0.56, p < 0.001) and was elevated in the patients who did not survive when compared to survivors (p < 0.03). iCT was not significantly related to the degree of serum calcium (mean 2.22 +/- 0.15 SD mmol/l). Gel chromatography in a fast protein liquid chromatography (FPLC) system of serum from 4 patients with elevated iCT disclosed that a majority of the measured CT was not due to monomeric CT, but high molecular CT. CONCLUSIONS: Pronounced elevations in circulating iCT were seen during the first 24 h critically ill patients. As the major part of the iCT consisted of high molecular weight CT this would not induce hypocalcemia. Rather, the elevated iCT would be regarded as a part of the metabolic responses to illness.

APACHE↗
PubMed1995

Increased level of hemoglobin A1c, but not impaired insulin sensitivity, found in hypertensive and normotensive smokers.

Smoking is associated with an abnormal plasma lipoprotein pattern. Recently, both insulin resistance and normal insulin action have been reported in smokers. In a total of 191 hypertensive and normotensive subjects recruited from a health survey, serum lipoprotein lipids, glucose tolerance (by intravenous glucose tolerance test (IVGTT), insulin secretion, and insulin sensitivity (euglycemic insulin clamp) were compared in the 41 smokers and 150 nonsmokers. Subjects were examined in the morning during a fasting state and after abstinence from smoking for 10 to 12 hours. Smokers showed a higher level of hemoglobin A1c (HbA1c) as compared with nonsmokers, 4.9% versus 4.7% (P < .05). There were no significant differences in fasting glucose, insulin, or insulin-mediated glucose disposal. However, a number of indices of insulin sensitivity tended to show enhanced insulin action among smokers. Only lower glucose and insulin values during the late phase (40 to 90 minutes) of the IVGTT reached statistical significance. Compared with nonsmokers, smokers had an expected higher level of serum triglycerides (2.1 v 1.8 mmol/L, P < .05) and an increased low-density lipoprotein (LDL) to high-density lipoprotein (HDL) cholesterol ratio (4.5 v 3.9, P < .05). These differences between smokers and nonsmokers were similar in both hypertensives and normotensives. In conclusion, smokers examined in the abstinence phase showed no signs of impaired insulin action. Lipoprotein abnormalities and elevated HbA1c may be caused in part by the insulin resistance induced during acute smoking and therefore may be quantitatively related to the time exposed to smoking. The effect on insulin sensitivity appears to be reversible over 10 to 12 hours.

Blood Glucose↗
PubMed1995

Vitamin D is related to blood pressure and other cardiovascular risk factors in middle-aged men.

A previous study has shown that serum levels of the active vitamin D metabolite 1,25-(OH)2-vitamin D were inversely related to blood pressure levels while the prohormone 25-OH-vitamin D was found to be related to insulin metabolism. Also other clinical and experimental data support the view that vitamin D metabolism is involved in blood pressure regulation and other metabolic processes. The present study was conducted in order to see if the above mentioned relationships between the vitamin D endocrine system and blood pressure, as well as other cardiovascular risk factors, could be found in a cross-section population-based study. Serum levels of 1,25-(OH)2-vitamin D, 25-OH-vitamin D, and blood pressure were therefore measured in 34 middle-aged men and metabolic cardiovascular risk factors were evaluated by means of intravenous glucose and fat tolerance tests, euglycemic hyperinsulinemic clamp, lipoprotein measurements, and lipoprotein lipase activity determinations. Serum levels of 1,25-(OH)2-vitamin D were found to be inversely correlated to the blood pressure (r = -0.42, P < .02), VLDL triglycerides (r = -0.47, P < .005), and to triglyceride removal at the intravenous fat tolerance test (r = 0.34, P < .05), while serum levels of 25-OH-vitamin D were correlated to fasting insulin (r = -0.35, P < .05), insulin sensitivity during clamp (r = 0.54, P < .001), and lipoprotein lipase activity both in adiposal tissue (r = 0.48, P < .005) and skeletal muscle (r = 0.38, P < .03).(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed1995

Localization of the gene for congenital dyserythropoietic anemia type III, CDAN3, to chromosome 15q21-q25.

Congenital dyserythropoietic anemia, type III (CDA III) is a rare autosomal dominant disorder characterized by macrocytic anemia, bone marrow erythroid hyperplasia and giant multinucleate erythroblasts. We have genetically characterized a large Swedish family in which the concurrence of CDA III and myeloma or benign monoclonal gammopathy is significantly higher than expected and have found that the causative genetic defect for CDA III maps to an 11 cM interval within 15q21-q25.

Anemia, Dyserythropoietic, Congenital↗
PubMed1995

Metabolic gas exchange during different surgical procedures.

Surgery performed during general anaesthesia has been shown to induce an increase in oxygen consumption. It is postulated that this response might be influenced by the surgical procedure performed. Metabolic gas exchange was continuously measured by indirect calorimetry for 30 min in 45 patients undergoing four different surgical procedures during general anaesthesia with propofol/fentanyl/vecuronium as follows: elective laparotomy (n = 13); emergency laparotomy (n = 10); elective knee joint arthroscopy (n = 10); gynaecological laparoscopy (n = 12). A significant increase in oxygen consumption occurred in all the groups within 5 min of skin incision. The greatest increase was seen in those undergoing elective laparotomy (+13%, p < 0.001 at 15 min), with similar smaller increases in the other three groups (+6 to +7%, p < 0.05). Surgery induced an increase in systolic blood pressure in all four groups, being most pronounced in the elective laparotomy group (+47% 15 min after skin incision, p < 0.001). These patients also experienced a significant rise in heart rate (+14%, p < 0.01 at 15 min). Carbon dioxide production increased both in the laparoscopy patients (+9%, p < 0.05) and, transiently, in the elective laparotomy group (+6% at 15 min, p < 0.01), but decreased in the other two groups (-7 to -15%, p < 0.05). Surgery induced a parallel increase in both oxygen consumption and systolic blood pressure in all types of operations, although the magnitude varied. Continuous measurement of metabolic gas exchange may provide an additional method of evaluating the metabolic response to different types of surgery.

Adult↗
PubMed1995

Veno-arterial carbon dioxide and pH gradients and survival in critical illness.

Recent studies have shown that the veno-arterial gradient for carbon dioxide (dVApCO2) is increased in the case of low cardiac index (CI). In order to further investigate this matter 220 haemodynamic measurements from 34 patients with septic shock and from 28 patients in the post-operative state without sepsis were evaluated. The arteriovenous gradient for pH (dAVpH) was also evaluated. CI was found to be inversely correlated to both dVApCO2 and dAVpH when the two groups of patients were analysed separately (r = -0.76 and r = -0.78, P < 0.001 for the relationship between CI and dVApCO2, r = -0.58 and r = -0.69, P < 0.001 for the relationship between CI and dAVpH). When volume loading over 2h was used to increase CI, 58-66% of the patients in the two groups showed a decline in dVApCO2 > 10% when CI was increased by > 10%. The corresponding values for a reduction in dAVpH > 10% during volume loading was 36-52%. While dAVpH was found to be increased in non-survivors (n = 27) when compared to survivors (0.32 +/- 0.01 vs. 0.24 +/- 0.1, P < 0.05) at the second day in the IUC, dVApCO2 was not a significant predictor of mortality despite the fact that CI was found to be decreased in the non-survivors (3.5 +/- 0.94 vs. 4.3 +/- 1.0 L min-1 m-2, P < 0.01). In conclusion, the veno-arterial carbon dioxide gradient was found to be inversely correlated to cardiac performance in patients both in patients with septic shock and in non-septic post-operative patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗