Biomedical subjects

Odd Mørkve

Publications and source records attributed to Odd Mørkve.

8 recordsLinked to original sources

PubMed2006

Immunohistochemistry using a Mycobacterium tuberculosis complex specific antibody for improved diagnosis of tuberculous lymphadenitis.

The clinical and histological criteria used to diagnose lymphadenitis caused by Mycobacterium tuberculosis complex organisms have poor specificity. Acid-fast staining and culture has low sensitivity and specificity. We report a novel method for diagnosis of tuberculosis that uses immunohistochemistry to detect the secreted mycobacterial antigen MPT64 on formalin-fixed tissue biopsies. This antigen has not been detected in non-tuberculous mycobacteria. Polymerase chain reaction (PCR) for amplification of IS6110 from DNA obtained from the biopsies was used as a gold standard. Fifty-five cases of granulomatous lymphadenitis with histologically suspected tuberculosis obtained from Norway and Tanzania were evaluated. Four known tuberculosis cases were used as positive controls, and 16 biopsies (12 foreign body granulomas and four other non-granulomatous cases) as negative controls. With immunohistochemistry, 64% (35/55) and with PCR, 60% (33/55) of granulomatous lymphadenitis cases were positive. Using PCR as the gold standard, the classical tuberculosis histology had sensitivity, specificity, positive and negative predictive values of 92, 37, 60, and 81%, respectively, and immunohistochemistry had sensitivity, specificity, positive and negative predictive values of 90, 83, 86, and 88%, respectively. The observed agreement between PCR and immunohistochemistry was 87% (kappa = 0.73). Immunohistochemistry with anti-MPT64 antiserum is a rapid, sensitive, and specific method for establishing an etiological diagnosis of tuberculosis in histologic specimens. Immunohistochemistry has the advantages over PCR of being robust and cheap, and it can easily be used in a routine laboratory.

Adolescent↗

PubMed2006

Tuberculosis case-finding through a village outreach programme in a rural setting in southern Ethiopia: community randomized trial.

OBJECTIVE: To ascertain whether case-finding through community outreach in a rural setting has an effect on case-notification rate, symptom duration, and treatment outcome of smear-positive tuberculosis (TB). METHODS: We randomly allocated 32 rural communities to intervention or control groups. In intervention communities, health workers from seven health centres held monthly diagnostic outreach clinics at which they obtained sputum samples for sputum microscopy from symptomatic TB suspects. In addition, trained community promoters distributed leaflets and discussed symptoms of TB during house visits and at popular gatherings. Symptomatic individuals were encouraged to visit the outreach team or a nearby health facility. In control communities, cases were detected through passive case-finding among symptomatic suspects reporting to health facilities. Smear-positive TB patients from the intervention and control communities diagnosed during the study period were prospectively enrolled. FINDINGS: In the 1-year study period, 159 and 221 cases of smear-positive TB were detected in the intervention and control groups, respectively. Case-notification rates in all age groups were 124.6/10(5) and 98.1/10(5) person-years, respectively (P = 0.12). The corresponding rates in adults older than 14 years were 207/10(5) and 158/10(5) person-years, respectively (P = 0.09). The proportion of patients with >3 months' symptom duration was 41% in the intervention group compared with 63% in the control group (P<0.001). Pre-treatment symptom duration in the intervention group fell by 55-60% compared with 3-20% in the control group. In the intervention and control groups, 81% and 75%, respectively of patients successfully completed treatment (P = 0.12). CONCLUSION: The intervention was effective in improving the speed but not the extent of case finding for smear-positive TB in this setting. Both groups had comparable treatment outcomes.

Adolescent↗

PubMed2006

Immunohistochemical analysis of cytokines and apoptosis in tuberculous lymphadenitis.

Relatively little is known about the effector mechanisms whereby the human immune system controls Mycobacterium tuberculosis infection. In this study we elaborate on the immune response and mechanisms of persistence of mycobacteria in lesions by analysing, using immunohistochemistry, the expression of cytokines [tumour necrosis factor-alpha (TNF-alpha), interleukin-10 (IL-10), transforming growth factor-beta (TGF-beta) and interferon-gamma (IFN-gamma)], apoptotic cells and apoptosis-related proteins [Bcl2, Bax, Fas ligand (FasL) and Fas] in the human tuberculous lymphadenitis lesions. The expression of apoptosis-related proteins has been shown to be exploited by mycobacteria to evade the immune response and persist in the host. Foreign body (FB) granulomas were used as controls. In tuberculosis (TB) granulomas, epithelioid cells and multinucleated giant cells expressed cytokines differently. In epithelioid cells, the numbers of TNF-alpha-, IL-10- and TGF-beta-stained cells were higher than IFN-gamma-stained cells (P < 0.01). TGF-beta and FasL were strongly expressed in the necrotic centres as compared with other cytokines. More giant cells expressed IL-10 and TGF-beta than expressed TNF-alpha and IFN-gamma (P < 0.01). Staining of consecutive sections revealed that some giant cells expressed IL-10 but not TNF-alpha. Apoptotic TB giant cells correlated positively with the expression of TNF-alpha, IFN-gamma and TGF-beta, but not with the expression of IL-10. The percentage of giant cells expressing Bax was lower than those expressing Fas, unlike the epithelioid cells, suggesting that TB giant cells are less susceptible to apoptosis. Compared with FB giant cells, there were fewer TB giant cells showing TNF-alpha, IFN-gamma, FasL, Fas expression or undergoing apoptosis (P < 0.05). Taken together, these observations show that the cellular microenvironment of TB granulomas down-regulates microbicidal functions, favouring bacillary survival and persistence. TGF-beta and FasL may be responsible for tissue destruction. The giant cells, being less susceptible to apoptosis, may remain a continuous source of pro-inflammatory cytokines, causing immune pathology.

Adolescent↗

PubMed2005

Respiratory symptoms and obstructive pulmonary disease in a population aged over 70 years.

STUDY QUESTION: What is the prevalence of respiratory symptoms and obstructive pulmonary disease by age, sex, and smoking history in a population aged 70 years and older? What is the association between selected comorbidities and obstructive pulmonary disease? PATIENTS AND METHODS: A questionnaire on respiratory symptoms and disease, selected comorbidities, and smoking history was mailed to a cross-sectional, sex- and age-stratified, random sample of the population 70 years and older of Bergen, Norway. RESULTS: About 11% of these elderly persons reported having at least one current obstructive pulmonary disease, 8% reported daily wheezing, and 12% reported significant dyspnea. The only respiratory symptom or disorder to show any clear age-related pattern was dyspnea, which increased through age 89 before declining. Dyspnea, current asthma, and current chronic bronchitis were about half as likely in males as females, after adjusting for smoking pack-years. Persons with obstructive pulmonary disease reported problems with walking, heart disease, and muscle/joint disease more frequently than those without. CONCLUSIONS: The prevalence of respiratory symptoms and obstructive pulmonary disease has been estimated. Only dyspnea was associated with age in this elderly population. Female sex was a predictor of dyspnea, current asthma, and current chronic bronchitis.

Age Factors↗

PubMed2005

Significance of Fas and Fas ligand in tuberculous lymphadenitis.

The Fas/Fas-ligand (FasL) system plays an important role in regulation of apoptosis and the immune response, and is exploited by mycobacteria to evade the immune response. This study was performed to investigate the distribution and levels of FasL and Fas in lymph node granulomas and sera of tuberculous lymphadenitis patients by immunohistochemistry and enzyme-linked immunosorbent assay. The validity of soluble Fas (sFas) or soluble FasL (sFasL) as a diagnostic tool was also examined. Levels of sFasL in serum were elevated among patients. The numbers of FasL stained cells in lymph node granulomas were higher than Fas. Children had significantly higher levels of sFasL as compared to adults. The human immunodeficiency virus (HIV)-tuberculosis (TB)-coinfected patients displayed no differences in the levels of sFasL or sFas compared with HIV-negative patients. The healthy controls from a high endemic tuberculosis country (having latent TB) had significantly higher levels of sFasL than from a country with no TB transmission. The sensitivity and specificity of the FasL and Fas test were low when compared with the culture results as the gold standard. However, by using histology as the gold standard, the sensitivity and specificity of the FasL test were increased to 66.7% and 100%, respectively, but for the Fas test remained low. In conclusion, sFasL and sFas cannot be used as diagnostic tests for tuberculous lymphadenitis. However, its utility in detecting latent TB and childhood tuberculous lymphadenitis remains to be evaluated. FasL seems to play a role in immune modulation and pathogenesis of TB. Modulators of Fas/FasL-mediated apoptosis may therefore be clinically useful.

Adolescent↗

PubMed2004

Reference values for arterial blood gases in the elderly.

OBJECTIVES: We present reference values for arterial blood gas measurements for persons > 70 years old. At the same time, we wish to examine how different criteria for exclusion from the reference sample with regard to previous smoking and various comorbidities might influence reference values. METHODS: After first screening a random sample of the general elderly population by postal questionnaire, we selected 146 men and women without respiratory disease, significant dyspnea, symptomatic heart disease or hypertension, or current smoker status. Arterial blood samples were drawn from subjects while in the supine position. RESULTS: The mean (SD; lower limit of normal) PaO(2) and arterial oxygen saturation (SaO(2)) for men was 77.0 mm Hg (9.1; 62.0) and 95.3% (1.4; 93.0), respectively, and for women was 73.5 mm Hg (8.4; 59.6) and 94.8% (1.7; 92.0). Mean (SD; upper limit of normal) PaCO(2) was 39.4 mm Hg (3.3; 44.8) for both sexes. None of the blood gas variables were associated with age, smoking history, or presence of various comorbidities. CONCLUSIONS: The reference values for PaO(2) and SaO(2) in elderly persons are sex specific but age independent. Ex-smokers and persons with nonpulmonary comorbidities who do not have significant respiratory symptoms need not be excluded from the reference sample for arterial blood gases.

Age Factors↗

PubMed2003

Are the "myths" of low back pain alive in the general Norwegian population?

AIM: The aim of this study was to examine the perception of low back pain care and consequences according to what Deyo refers to as seven "myths" about back pain, in the Norwegian population. METHODS: In spring 2001, seven questions, corresponding to Deyo's myths, were included in an opinion poll (telephone interviews) of a representative sample (n=1015) of the Norwegian population. RESULTS: In total, 41% of the population held that 'If you have a slipped disc you must have surgery'. Approximately 50% believed that 'X-ray and newer imaging tests can always identify the cause of pain' and 'Most back pain is caused by injury and heavy lifting'. Almost 60% agreed that 'Everyone with back pain should have a spine X-ray'. However, only one-quarter believed that 'If your back hurts, you should take it easy until the pain goes away', and approximately one-fifth believed that 'Back pain is usually disabling'. Only 12% believed that 'Bed rest is the mainstay of therapy'. More individuals in the lower- compared with the higher-educated groups believed in the myths. CONCLUSION: Information concerning current knowledge on healthcare and health consequences of low back pain had reached only a small part of the general population. The most important factor for lack of knowledge was education. Developing effective methods to promote adequate self-care and treatment and reduce the risk of chronicity of low back pain in the lower-educated groups should be a top priority.

Adult↗

PubMed2002

Effect of body position on arterial oxygen tension in the elderly.

BACKGROUND: It is well known that body position can have an effect on gas exchange though the magnitude of this effect has not been studied thoroughly in the elderly. OBJECTIVES: This study analyzes the effect body position change has on arterial oxygen tension (PaO(2)) and arterial carbon dioxide tension (PaCO(2)) in healthy elderly. METHODS: We tested 46 "lung-healthy" elderly, including 30 women and 16 men, 67-88 years of age. Blood was drawn from the radial artery first in the sitting position and subsequently in the supine position. Spirometry was performed. RESULTS: Mean (SD) sitting PaO(2) was 10.53 kPa (1.22), whereas mean supine PaO(2) was 9.85 kPa (1.33). The difference between sitting and supine PaO(2) was 0.68 kPa (0.86) and was statistically significant. Sitting PaCO(2) was 5.06 kPa (0.47) and supine PaCO(2) was 5.05 kPa (0.54). The difference between sitting and supine PaO(2) correlated positively with FEV(1)/FVC %, negatively with the corresponding difference between sitting and supine PaCO(2), and negatively with BMI. CONCLUSIONS: We conclude that the significant difference in PaO(2) in sitting and supine positions clearly shows that the position needs to be considered both when attempting to establish reference values and when evaluating gas exchange in elderly persons. The positional changes in oxygenation are related to the corresponding change in PaCO(2), and to FEV(1)/FVC % and BMI.

Aged↗